SEPSIS

Question 1

What is the sepsis pathway?

Answer 1

The sepsis pathways align with the relevant BTF Standard Observation Charts and support clinicians to ‘Recognise, Resuscitate and Refer’ for initial sepsis management.

For adults the yellow criteria is composed of respirations that are lower than 10 or higher than 25. Spo2 that is lower than 95%, SBP lower than 100mgHg, HR lower than 50 or higher than 120, altered consciousness or confusion and a temp lower than 36.5 or higher than 38.5.

Question 2

What are the resuscitative interventions for the septic patient (BUFALO)?

Answer 2

1. Bloods
2. Urine monitoring (sepsis can cause acute kidney injury)
3. Fluids (combat hypotension)
4. Antibiotics
5. Lactate (increased lactate reflects lactic acid and shock status, normal = <1.0 mmol/L
6. Oxygen

Question 3

What is the pathophysiology of sepsis?

Answer 3

Starts with infection (redness, swelling, pain, heat, loss of function)

Sepsis - life-threatening organ dysfunction caused by dysregulated host response to infection
(sepsis develops chemicals are released by the immune system into the bloodstream, thus causing widespread systemic inflammation)

Septic shock - subset of sepsis with circulatory and cellular/metabolic dysfunction associated with higher risk of mortality

Question 4

What are the most common sources of infection?

Answer 4

Respiratory
Post operative infection
Lungs
Catheter site
Device related
Central nervous system
Bacteraemia
Abdominal
Endocarditis

Question 5

Sepsis risk factors for adults and children?

Answer 5

Adults
Immunocompromised
IDUC
Recent surgery or invasive procedure
History of fever or rigors
Drains and open wounds
Over 65 years

Children
<3 months old
Re-presentation within 48 hours
Immunocompromised
Indwelling medical device
High level of parental concern

Question 6

Nursing responsibilities in identifying a deteriorating patient?

Answer 6

DRSABCD
A-G
Escalate to the appropriate clinical review/rapid response
Stabilise the patient with nursing interventions
Call for help
Listen to the concerns of the patient and advocate!
Sepsis 6

Question 7

What is the process for escalation of care?

Answer 7

• Call clinical review
• Treat symptoms
• Find out cause
• Antibiotics
• Fluids/oxygen
• Monitor ^

Question 8

Early signs of deterioration in Sepsis?

Answer 8

decrease in GCS and alteration in mental state
tachycardia/bradycardia
Decrease in urine output
Chest pain
Desaturation
Respiratory rate <10 or >30

Question 9

Late signs of deterioration in Sepsis?

Answer 9

GCS <9 or unresponsive
RR <5 or >40
BGL <2mmol or >25mmol
Airway obstruction/stridor
HR <40 or >140
Anuria

Question 10

Identify signs of inadequate perfusion

Answer 10

• Tachypnoea
• Tachycardia
• Vasoconstriction – cool, diaphoretic skin
• Altered LOC
• Decreased urine output/anuria
• Hypotension

Question 11

What is the Systemic Inflammatory Response Synrome (SIRS)?

Answer 11

Clinical symptoms in response to a pathogen

characterised by a number of criteria including
fever >38.0°C or hypothermia <36.0°C, tachycardia >90 beats/minute, tachypnea >20
breaths/minute

AT least 2 of these criteria PLUS a source of infection is enough to enable a sepsis diagnosis.

Question 12

How can we diagnose sepsis?

Answer 12

2 or more SIRS signs + suspected or confirmed infection

Question 13

How can we diagnose severe sepsis?

Answer 13

Sepsis + Multi Organ Dysfunction Syndrome (MODS)

Question 14

Describe 3 types of septic shock

Answer 14

1. Hypovalaemic shock
   - Severe blood/fluids loss make the heart unable to pump enough blood to the body
2. Cardiogenic shock
   - Heart cannot pump blood and oxygen to the brain and other organs
3. Distributive shock
   - when blood vessels are extremely dilated = decreased BP –> body can’t get enough blood to the heart, brain and kidneys - caused by sepsis