Sepsis Flashcards
Define sepsis
life-threatening organ dysfunction caused by a dysregulated host response to an infection
Define septic shock
a more severe form sepsis, technically defined as ‘in which circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone’
What are the red flag criteria for sepsis?
Decreased responsiveness
Acute confusional state
SBP < 90 (or drop >40 from normal)
HR > 130
RR > 25
Needs O2 for sate >92%
Non-blanching rash, mottled/ ashen/ cyanotic
Not urine in 18 h/ UO < 0.5 ml/kg/hr
Lactate >=2 mmol/l
Recent chemo
What are amber flags for sepsis?
Relatives concerned about mental status
Acute decrease in functional ability
Immunosuppressed
Trauma/Surgery past 6 weeks
RR 21-24
HR 91-130 or new dysrhythmia
SBP 91-100
No urine 12-18 hrs
Low temp
Signs of wound/skin infection
What are the sepsis 6?
Give 3, Take 3
Give:
O2
Broad spec ABs
IV fluids
Take:
Blood cultures
Serum lactate
Hourly UO
What are the aims of the sepsis 6?
- Administer oxygen: Aim to keep saturations > 94% (88-92% if at risk of CO2 retention e.g. COPD)
- Take blood cultures
- Give broad spectrum antibiotics
- Give intravenous fluid challenges: NICE recommend a bolus of 500ml crystalloid over less than 15 minutes
- Measure serum lactate
- Measure accurate hourly urine output
What score is used to identify and categorise patients?
SOFA
Sequential Organ Failure Assessment Score
NEWS2
What does SOFA look at?
PAO2 Platelets Bilirubin MAP GCS Creatinine UO
What should be done if NEWS2 is 5 or more?
Urgent assessment by a senior clinical decision-maker
What are some RFs for Sepsis?
>65 years old Immunocompromised Lines or Catheters Recent surgery Haemodialysis DM IV drug misuse Alcoholism Pregnancy Skin e.g. burns, cuts
How is sepsis treated in the hospital?
A-E management
Broad-spec IV ABs Reassess and monitor Find source of infection Fluid resus Consider O2 \+/- vasopressor, inotrope, corticosteroid
