Sepsis

Question 1

Define sepsis

Answer 1

life-threatening organ dysfunction caused by a dysregulated host response to infection

Question 2

Define Systemic Inflammatory Response Syndrome (SIRS)

Answer 2

> 2 of the following
- Temperature > 38oC or < 36oC
- Heart rate > 90 bpm
- Respiratory rate > 20 bpm
- WBC count >12 x 109/L or < 4 x 109 / L or 10% immature forms (bands)

Question 3

Define severe sepsis and septic shock

Answer 3

Severe sepsis = Sepsis + organ dysfunction (renal, respiratory, hepatic, haematological, CNS, cardiovascular) +/- DIC
- Including (but not limited to) lactic acidosis, oliguria, acute mental status changes

Septic shock = Hypotension (despite fluid resuscitation) + Hypoperfusion
In septic shock, hypotension = SBP < 90 mmHg or reduction of >40 mmHg from baseline in absence of other causes

Question 4

Management for sepsis

Answer 4

Sepsis 6
1. High flow oxygen 15L/min non-rebreathe
2. IV/IO access
- Blood cultures
- Glucose, FBC, CRP, U&Es, Cr, Clotting screen
3. VBG/ABG for lactate/glucose
4. Broad-spectrum Abx according to local guidelines
5. IV fluids - 20ml/kg bolus
6. Measure Urine output

Involve seniors within 3 hours if cause not identified or obs are not improving

Question 5

Investigations for sepsis

Answer 5

Urine MC&S / stool culture
b-hCG

Blood cultures x2
FBC
CRP (takes 12-24h to rise)
Glucose
Clotting
VBG/ABG

CXR
LP

Question 6

Complications of sepsis

Answer 6

Myocardial dysfunction
AKI (from reduced CO)
Disseminated intravascular coagulation (DIC)
Hypoglycaemia/hyperglycaemia
Neuromuscular weakness
Necrotising enterocolitis
Multi-organ failure
Persistent pulmonary hypertension of the newborn
Thyroid insufficiency
Hypocalcaemia