Sepsis

Question 1

Why is sepsis different to SIRS?

Answer 1

SIRS is an increased inflammatory response whereas sepsis involves both pro-inflammatory and anti-inflammatory aspects
People react differently to infection in sepsis depending on their premorbid state and comorbidities

Question 2

What are the 5 relevant features of SIRS?

Answer 2

temperature below 36 or above 39 (news)
HR above 90 (news of 1)
RR above 20 (news of 2)
PaCO2 under 4.3
WCC above 12000 or below 4000

Question 3

What differentiates sepsis from an uncomplicated infection?

Answer 3

Organ dysfunction

Question 4

Difference between sepsis and septic shock?

Answer 4

Septic shock is a subset of sepsis where the infection is profound enough that CVS is effected, cellular and metabolic abnormalities effected to a point of an increased mortality risk

Question 5

What does a patient with sepsis require to maintain MAP? what MAP is aimed for? What does their lactate stay at despite adequate perfusion?

Answer 5

vasopressors
65
Lactate remains over 2

Question 6

What is the hospital mortality of septic shock?

Answer 6

Over 40%

Question 7

SOFA?

Answer 7

Sepsis-associated organ failure assessment

Determines presence and risk of organ failure

Question 8

Why can’t SOFA be used at bedside? what can be used instead?

Answer 8

SOFA is complex with blood tests required

Can use q-SOFA (quick SOFA) which uses NEWS chart

Question 9

What 7 things does SOFA take into account?

Answer 9

PaO2
Platelet count
Bilirubin
MAP
GCS
Creatinine
UO

Question 10

What 3 things are looked at on the q-SOFA score? WHat is a serious score? If any points are scored at all what is the protocol?

Answer 10

GCS - if its below 15
RR - if its above 22
SBP - if its below 100
1 point for each, 2 points is serious
Any points - ABCDE, blood and cultures/U&E/LFT/FBP, imaging

Question 11

NICE risk stratification of sepsis have what of the following as high risk criteria and moderate risk:
History
Respiratory
BP
Circulation (HR)
Hydration
Skin

Answer 11

History of objective change to mental state is high risk whereas collateral history of changed mental state/ surgery or trauma in last 6 weeks/ acute functional decline is moderate risk
Respiratory rate above 25 is high risk, 21-24 is moderate plus need for oxygen to maintain sats 92 or 88 in COPD is high risk
SBP below 90 is high risk (or more than 40 below normal) and SBP below 100 is moderate risk
HR above 130 is high risk, HR above 90 is moderate risk
UO less than 0.5/kg/hour is high risk and same for moderate 0.5-1
Mottled skin with rash or cyanosis is high risk

Question 12

Sepsis 6?

Answer 12

Give fluids 
Take blood cultures
Lactate level
UO
Oxygen
Give antibiotics

Question 13

What O2 sats are you aiming for in sepsis 6?

Answer 13

Oxygen sats at 92-96 or 88-92 in COPD

Question 14

What culture samples do you take in sepsis 6 and when?

Answer 14

Blood, sputum and CSF if needed

Take before you give broad spec antibiotics

Question 15

What 2 patient conditions require IV fluid bolus?

Answer 15

Hypotensive or lactate above 2mmol/l

Question 16

What rate of fluid bolus administration do you give in sepsis? what is total you can give? how do patient characteristics effect this?

Answer 16

500mls 0.9% saline or haartmans over 15 mins
up to 2/2.5l men/women
Elderly, cardiac or renal failure then seek help

Question 17

How often do you check lactate levels? When do they reach critical point?

Answer 17

Check after every litre of fluid administered

If lactate reaches 4 then critical care

Question 18

What 5 states require escalation to ICU on Trusts NEWS chart despite sepsis 6 being applied?

Answer 18

If after sepsis 6,
lactate remains high
GCS drops
Aggitated despite resus
RR above 25
SBP 90-100