Sepsis Flashcards
What is sepsis?
Sepsis is the life-threatening organ dysfunction caused by an abnormal and uncontrolled host response to an infection.
It is the leading cause of death in intensive care units, and has an overall mortality of 30-40%. It is a condition that is essential to identify and treat early and aggressively, as any patient admitted to hospital with sepsis has a 10% increased risk of mortality.
Briefly describe the criteria for sepsis
The criteria for sepsis aim to aid the early identification of patients developing (or with) a clinical picture of sepsis. There are two criteria both required for a diagnosis of sepsis:
- Presence of a known or suspected infection
- Clinical features of organ dysfunction
- Calculating a ‘SOFA score’ is a means by which clinicians can quantify the level of organ dysfunction
What is the function of the SOFA score?
For a patient with a known or suspected infection, a SOFA score greater than or equal to two indicates sepsis; the SOFA score can also be used to monitor and quantify a patient’s clinical course and response to treatment for sepsis.
Briefly describe the qSOFA score
The qSOFA score is a shortened version of the full SOFA criteria. It was developed to allow for the rapid assessment of potential sepsis, based purely on clinical signs.
The qSOFA score permits the diagnosis of potential sepsis to be made prior to any investigations and can be completed by any healthcare professional.
Any patient with a known or suspected infection and a qSOFA score ≥2 should be investigated and managed for sepsis as necessary. The qSOFA criteria are:
- Respiratory Rate ≥ 22/min (1 point)
- Altered Mental State (1 point)
- Systolic Blood Pressure ≤100mmHg (1 point)
How quick does Sepsis Six need to be initiated in sepsis?
Should be completed within one hour of diagnosing sepsis.
Briefly describe Sepsis Six
- Oxygen
- IV fluid therapy
- Blood cultures
- IV antibiotics
- Routine bloods
- Monitor urine output
Briefly describe oxygen therapy for sepsis
Start 15L O2 via a non-rebreathable mask, aiming for target saturations 94-98% (or 88-92% in chronic retainers), only titrating once appropriately saturating.
Briefly describe IV fluid therapy in sepsis
500-1000mL initial fluid bolus, followed by ongoing fluid status re-assessment.
Briefly describe blood cultures in sepsis
Take blood cultures prior to administering antibiotics, along with any other relevant cultures from the suspected infection site.
Briefly describe IV antibiotics in sepsis
Start empirical antibiotics (based on local guidelines), before switching to targeted therapy when sensitivities are available.
In Leicester, what antibiotic is given for sepsis?
What routine bloods are taken for sepsis?
Routine bloods should include FBC, U&E, LFTs, clotting, CRP, and glucose; lactate can be quickly be assessed rapidly from a blood gas.
Briefly describe urine output moniroting in sepsis
Catheterise the patient if appropriate and accurately monitor urine output; aim for at least >0.5mL/kg/hour.
What further management may be needed following sepsis six?
Further management may include assessment by intensive care teams and commencing vasopressor agents (e.g. noradrenaline), renal replacement therapy, and/or ventilator support.
How can the source of infection in sepsis be identified?
Identification of the infection source is important in the investigation of sepsis cases. Appropriate investigations may include:
- Urine dip +/- culture
- Chest X-ray (CXR)
- Swabs (e.g. surgical wounds)
- Operative site assessment (via CT or US imaging)
- Cerebrospinal fluid sample (via LP)
- Stool culture
