S3 Sepsis

Question 1

What is sepsis?

Answer 1

Life-threatening organ dysfunction due to a dysregulated host response to infection

Question 2

What is septic shock?

Answer 2

A subset of sepsis where particularly profound circulatory, cellular and metabolic abnormalities substantially increase mortality

Question 3

What is sepsis characterised by?

Answer 3

Inflammation

Question 4

What effect does sepsis have on organ systems (ABCDE)?

Answer 4

• Airways - decreased consciousness may be a risk of airway problems but no specific effect unless infection arises from throat/neck
• Breathing - tachypnoea, fluids leaking into interstitial tissue leads to lung oedema and decreased lung compliance
• Circulation - hypovolaemia due to vasodilation and capillary leakage leads to hypotension, tachycardia, end organ damage
• Disability - reduced blood flow to brain (confusion, drowsiness, anxiety, low consciousness, etc)
• Exposure - high temp

Question 5

What is the SEPSIS pneumonic?

Answer 5

Slurred speech/confusion
Extreme shivering/muscle pain
Passing no urine (in a day)
Severe breathlessness
It feels like you’re going to die
Skin mottled/discoloured

Question 6

Who is at higher risk of sepsis?

Answer 6

• very young (under 1yo)
• elderly (over 75yo) or very frail
• pregnant, post-partum (in the last 6 weeks) women
• patients with an impaired immune system due to illness or drugs

Question 7

What would make you ‘think’ sepsis?

Answer 7

If patient…

• triggered on EWS
• looks ill
• has signs of infection

Question 8

What does the EWS (NEWS2) measure/observe?

Answer 8

1. Respiratory rate
2. Oxygen saturation
3. Systolic blood pressure
4. Pulse rate
5. Level of consciousness/new confusion
6. Temperature

Question 9

What EWS score results in ‘think sepsis’?

Answer 9

A score of 5 or more and aren’t e.g. end of life

Question 10

What is red flag sepsis?

Answer 10

Patients who are high risk of deterioration

Question 11

What are the red flag sepsis criteria? How many do you need to score on to have red flag sepsis?

Answer 11

• AVPU
• acute confusion
• resp rate 25/min or above
• needs oxygen to keep at 92% or above
• has a heart rate over 130bpm
• the systolic BP is 90mmHg or below/drops 40mmHg below normal for patient
• no urine passed in last 18 hours/0.5ml/kg/hr
• non-blanching rash, mottled skin
• recent chemotherapy

One

Question 12

What is the sepsis 6? What are the 6 tasks?

Answer 12

A set of 6 tasks (a care bundle) that greatly increases a patients chance of survival if delivered within the first hour of recognition of sepsis

1. Give oxygen
2. Take cultures
3. Give antibiotics
4. Consider fluids
5. Take Hb and lactate
6. Monitor urine output

(3 give, 3 take)

Question 13

What is a common bacteria that can cause sepsis?

Answer 13

Meningococcus (Neisseria meningitidis)

Question 14

What is the tumbler test?

Answer 14

Place a clear tumbler against the rash, if when pressure is applied the rash disappears it is blanching, if not, it’s non-blanching

Question 15

What are some supportive investigations for sepsis?

Answer 15

• FBC
• blood sugar
• liver function tests
• CRP test

Question 16

What are some specific investigations for sepsis?

Answer 16

• CSF analysis

* throat swab