SEPSIS

Question 1

Clinical features indicating antibiotics

Answer 1

Objective evidence of new onset of an altered mental status.
Respiratory
New need for oxygen via reservoir mask to maintain SpO2 > 92% (or > 88% in known COPD).
Blood pressure
Systolic blood pressure ≤ 90 mmHg.
Systolic blood pressure > 40 mmHg below known normal.
Heart rate > 130/minute.
Skin Mottled or ashen appearance.
Petechiae or purpura.

Question 2

Features of concern

Answer 2

History or CNS examination
History from family/caregivers of new onset of an altered mental status.
History of acute deterioration of functional ability.
Impaired immune system (illness or drugs, including oral steroids).
Trauma, surgery or invasive procedures in the last six weeks.
Respiratory
Tachypnoea.
Blood pressure
Systolic blood pressure 91-100 mmHg.
Circulation and hydration
Heart rate 91-130/minute
New onset dysrhythmia.
Reduced urinary output.
Temperature
Tympanic temperature < 36°C.
Skin
Signs of potential infection, including redness, swelling or discharge at surgical site or breakdown of wound.

Question 3

ssess whether antibiotics are indicated (all the following must be present):

Answer 3

One or more clinical features indicating antibiotics (see the sepsis features table), and
The patient is aged greater than or equal to 12 years, and
Time to hospital is greater than 30 minutes.

Question 4

Administer an antibiotic if indicated:

Answer 4

1 g cefazolin IV if the source of sepsis appears to be the soft tissues or a joint.
2 g ceftriaxone IV for all other sources of sepsis.
Seek clinical advice regarding antibiotic administration if the patient is aged less than 12 years and is very unwell.

Question 5

Sepsis is present when

Answer 5

a microorganism invades a normally sterile part of the body, resulting in an immune response producing systemic signs and symptoms.