S3) Acute Sepsis in the Emergency Department

Question 1

What is sepsis?

Answer 1

Sepsis is life-threatening organ dysfunction due to dysregulated host response to infection

Question 2

What is septic shock?

Answer 2

Septic shock is persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation

Question 3

The terms sepsis, bacteraemia and septicaemia are not interchangeable.

Distinguish between them

Answer 3

• Bacteraemia is the presence of bacteria in the blood
• Septicaemia is generalised sepsis (outdated clinical term)
• Sepsis is a life-threatening response to infection

Question 4

What is an Early Warning Score?

Answer 4

An early warning score (EWS) is a guide used by medical services to quickly determine the degree of illness of a patient

Question 5

How do we recognise sepsis?

Answer 5

• Patients look sick or have raised EWS (3/more)
• Clinical suspicion of infection e.g. pneumonia, UTI, meningitis, etc
• Red Flag(s) e.g. high RR, low BP, unresponsive

Question 6

Identify 5 red flags for sepsis

Answer 6

• Patient is unresponsive/confused
• Non-blanching rash
• HR > 130 bpm
• RR > 25 bpm
• Systolic BP < 90 mmHg

Question 7

How does one react to a patient with Red Flag Sepsis?

Answer 7

Immediately:

• Inform senior doctor for review
• Send urgent investigations
• Complete Sepsis Six Bundle

Question 8

Identify 7 urgent investigations

Answer 8

• FBC
• Blood gases
• Blood sugar
• Urea and Electrolytes
• Liver Function Tests
• C-Reactive protein (CRP)
• Other microbiology samples (CSF, urine, etc)

Question 9

What is the Sepsis 6 Bundle?

Answer 9

• Give:

I. Oxygen

II. Antibiotics

III. Fluid challenge

• Take/measure:

I. Blood cultures

II. Lactate

III. Urine output

Question 10

How does one confirm the diagnosis of acute sepsis?

Answer 10

• Blood culture
• PCR of blood
• Microscopy, culture & PCR of CSF (through lumbar puncture)

Question 11

A lumbar puncture is only performed after checking contraindications.

Describe how CSF is examined

Answer 11

• Look at appearance (turbidity and colour)
• Microscopy of leukocytes and erythrocytes
• Gram stain performed
• Referral for PCR

Question 12

Identify 5 life-threatening complications of acute sepsis

Answer 12

• Irreversible hypotension
• Respiratory failure
• Acute kidney injury
• Raised intracranial pressure
• Ischaemic necrosis of digits/hands/feet

Question 13

What is meningococcal disease?

Answer 13

• Meningococcal disease is a bacterial form of meningitis, a serious infection of the meninges that affects the brain membrane
• It presents with a purpuric rash, light sensitivity, fever and neck stiffness

Question 14

Which pathogen causes meningoccocal disease?

Answer 14

Neisseria meningitidis

Question 15

How does meningococcal disease spread?

Answer 15

Spread by direct contact with respiratory secretions e.g. aerosols, nasopharyngeal secretions

Question 16

Describe the properties of the meningococcus bacteria – Neisseria meningitidis

Answer 16

• Gram-negative diplococcus
• Numerous serogroups e.g. A, B, C, W-135
• Outer membrane acts as an endotoxin
• Most people are harmlessly colonised

Question 17

Where are the different serogroups for meningitis derived from?

Answer 17

Different serogroups are based on the polysaccharide capsular antigen

Question 18

Which is the most predominant meningitis serogroup in England?

Answer 18

1000 cases/yr mainly Group B

Question 19

What are the preventions for meningococcal disease?

Answer 19

1. Prevention: Vaccination

I. Menningococcal C conjugate vaccine

II. ACWY vaccines

III. Serogroup B vaccines

2. Prevention: Antibiotic Prophylaxis