Sepsis

Question 1

What is sepsis?

Answer 1

Immune response to an infection causing systemic inflammation and impaired organ functioning
Causes raised lactate and DIC

Question 2

What are the risk factors?

Answer 2

Young or old patients
Long term medical conditions e.g. COPD/DM
Immunosuppression e.g. HIV/chemo
Recent surgery/trauma/burns
Pregnancy or peripartum
Indwelling lines

Question 3

What are the symptoms?

Answer 3

Signs of infection source e.g. dysuria
Fever
N&V
Diarrhoea
Malaise
Muscle aches
Slurred speech
SoB
Decreased urine
Cold and clammy

Question 4

What are signs of moderate risk sepsis?

Answer 4

Newly altered or new onset behaviour
HR 91-130
RR 21-25
Systolic 91-100mmHg
Urine- no urine in 12-18 hrs or 0.5-1ml/kg/hr if catheter
Temp <36
High risk patient e.g. HIV

Question 5

What are signs of high risk sepsis?

Answer 5

Newly onset altered behaviour
HR >130
RR>25
Systolic BP <90 or >40mmHg from baseline
No urine for 18hrs or <0.5ml/kg/hr if catheter
Skin- mottled or cyanosed or non blanching rash

Question 6

What investigations are needed?

Answer 6

Urine dip and culture
Bloods
-FBC
-CRP
-Cultures
-LFTs
-U&Es
-Blood gas
-Clotting

CXR
CT scan- abdo infection or abscess
Lumbar puncture- ?meningitis or encephalitis

Question 7

What is the management?

Answer 7

Escalate to senior
Sepsis 6
-blood cultures (2 from different sites)
-blood lactate
-catheterise and fluid balance
-high flow oxygen
-IV fluids
-IV abx

treated within 1 hr

Question 8

What is neutropenic sepsis and how is it managed?

Answer 8

Sepsis in pt with neutrophil count <1x10^9/L

Normally due to anti cancer or immunosuppressant therapy

• chemo
• clozapine
• methotrexate
• carbimazole
• quinine
• biologics

Low threshold to treat

• if temp >38 then treat as sepsis
• broad spectrum abx e.g. tazocin