Sepsis

Question 1

Risk factors of sepsis

Answer 1

Patient:

• Age
• Surgical history
• Trauma
• Wound
• Invasive lines (IDC, CVC)
• PMH: falls, immunocompromised, fever

Organisational:

• Nurse:patient
• Rural:urban
• Night:day
• Busyness
• Multiple HCP
• Activation threshold
• Monitoring frequency
• Experience/seniority

Question 2

Common sources of infection

Answer 2

• Abdomen: surgery, appendix, bowel perforation
• Lungs: pneumonia
• Skin: cellulitis, wound, CVC
• CNS: meningitis, brain abscess
• Urinary tract

Question 3

Signs of deterioration (early + late) **

Answer 3

Early:

• RR <10, >30
• HR bradycardia
• BP hypotension
• Sats <95%
• Decreased urine output
• Increased drain output
• Altered mental state
• Chest pain
• Lactate >2mmol/L

Late:

• RR <5, >40, airway obstruction
• HR <40, >140
• BP <80, >240
• Sats <90%
• Anuria
• GCS <9
• BGL <2, >24
• Seizures
• PaCO2 >60
• Lactate >4mmol/L

Question 4

Signs of inadequate perfusion

Answer 4

• Increased HR
• Increased RR
• Decreased BP
• Decreased urine
• Alt LOC (confusion, anxiety)
• Skin diaphoretic, cool

Question 5

Pathophysiology of sepsis

Answer 5

Infection - inflammatory mediators - vasodilation, endothelial dysfunction - maldistribution of microvascular blood flow - cellular hypoxia - cell death - multi organ failure

Question 6

Sepsis pathway + escalation

Answer 6

Risk factor + 2 yellow zones (early signs) = may have sepsis, clinical review, senior clinical, targeted hx + clinical examination

Risk factor + any red zone (SBP <90, lactate >4mmol/L, base excess

Question 7

Sepsis 6

Answer 7

B: bloods (2 sets)
U: urine output and monitor (15-30mins)
F: fluids (crystalloid)
A: antibiotic (IV)
L: lactate (early)
O: oxygen (95%)