Recognising Sepsis

Question 1

What is sepsis?

Answer 1

Sepsis is a medical emergency and a time-critical condition, sepsis is when your immune system overreacts as response to an infection which can lead to multiple organ failure.

Question 2

What are the signs of sepsis?

Answer 2

• Slurred speech
• Extreme shivering or muscle pain
• Passing no urine- in a day
• Severe breathlessness
• I feel like I might die
• Skin mottled or discoloured

Question 3

Who is at risk of sepsis?

Answer 3

• The very young (under 1 year)
• Older people (over 75) or very frail people
• Recent trauma or surgery or invasive procedure (within the last 6 weeks)
• Impaired immunity due to illness (for example diabetes) or drugs (for example long term steroids, chemotherapy or immunosuppressants)
• Indwelling line, catheters, intravenous drug misuse, any breach of skin integrity (for example, any cuts, burns, blisters or skin infections)

Question 4

Who is at risk for neutropenic sepsis?

Answer 4

• Additional risk for pregnant women who are pregnant or have been pregnant, given birth, had a termination or miscarriage within the past 6 weeks
• Gestational diabetes, diabetes or other comorbidities
• Needed invasive procedure, e.g caesarean section, forceps delivery, removal of retained products on conception
• Prolonged rupture of membranes
• Close contact with someone with group A streptococcal infection
• Continued vaginal bleeding or an offensive vaginal discharge

Question 5

What should you identify when looking for sepsis?

Answer 5

• Possible source of infection
• Risk factors for sepsis
• Indicators of clinical concern such as new onset abnormalities of behaviour, circulation or respiration

Question 6

What should you do if sepsis is suspected?

Answer 6

Use a structured set of observations to assess people in a face-to-face setting. Consider using early warning scores in acute hospital settings. Stratify risk of severe illness and death from sepsis using the tool appropriate to age and setting.

Question 7

What should you do if sepsis is not suspected?

Answer 7

No clinical cause for concern, no risk factors for sepsis- use clinical judgement to treat the person, using NICE guidance relevant to their diagnosis when available.

Question 8

What can be used to identify sepsis?

Answer 8

• NEWS2- vital observations (BP, CRT, HRT, RR, Sp02, temp)
• ABCDE- think, AVPU, BM, urine output, possible sources of infection
• Sepsis risk stratification tool 18+

Question 9

What is the sepsis 6 bundle?

Answer 9

1) Administer oxygen Aim to keep saturation >94% (88-92% if at risk of CO2 retention e.g COPD)
2) Take blood cultures- at least a peripheral set, consider e.g CSF, using, sputum- think source control urinalysis for all adults
3) Give IV antibiotics according to trust protocol
4) Give IV fluids
5) Check serial lactates- levels>2 mmol/L indicate sepsis
6) Measure urine output- may require urinary catheter. Ensure fluid balance chart commenced and completed hourly

Question 10

What are the signs of a low risk patient? (SRST)

Answer 10

• Normal behaviour
• No high risk or moderate risk criteria met
• No non-blanching rash

Question 11

What are the signs of a moderate risk patient? (SRST)

Answer 11

• Behaviour- history from patient, relative or friend of new onset altered behaviour or mental state
• Impaired immune system
• Trauma, surgery or invasive treatment in the last 6 weeks
• Respiratory rate of 21-24 BPM
• Heart rate of 91-130 BPM (pregnant women 100-130)
• Not passed urine in the last 12-18 hours
• Temperature less than 36 degrees
• Signs of potential infection (redness, swelling, discharge)
• BP- 91-100 mmHg

Question 12

What are the signs of a high risk patient? (SRST)

Answer 12

• Behaviour- objective evidence of new altered state
• HR- more than 130 BPM
• RP- 25 breaths per minute or more
• New need for 40% oxygen or more to maintain saturation of 92%
• BP- 90mmHg or less or more than 40 below normal
• Non-blanching rash
• Mottled or ashen appearance
• Not pass urine in 18 hours