SEPSIS

Question 1

How many deaths worldwide are caused by sepiss?

Answer 1

1 in 5

Question 2

In the UK, how many people have sepsis in a year?

Answer 2

250,000

Question 3

Mortality rate of sepsis and septic shock?

Answer 3

30% for sepsis
50% for septic shock

Question 4

How often does a person in the UK die from sepsis?

Answer 4

1 every 4 hours

Question 5

How much does sepsis cost the NHS every year?

Answer 5

About 2 billion

Question 6

What is sepsis?

Answer 6

A life-threatening organ dysfunction due to a dysregulated host immune system respnse to an infection

Question 7

What is septic shock?

Answer 7

Sepsis unresponsive to adequate fluid resuscitation

Question 8

What are the most common sites of infection that cause sepsis?

Answer 8

35% pneumonia
25% UTI
11% intra-abdominal infection
11% skin and soft tissue infection

Question 9

What patient groups are most at risk of sepsis?

Answer 9

> 75 or <1
Frail with complex comorbidities
Trauma, surgery, invasive procedure within the last 6 weeks
Immunodeficiency
Chemotherapy in last 2-3 weeks
Indwelling lines or catheters
IVDU
Pregnant
Breaches of skin integrity e.g. cuts, burns, blisters, skin infections

Question 10

Screening tools for sepsis?

Answer 10

NEWS
MEWS
QuickSOFA score

Question 11

What is the QuickSOFA score?

Answer 11

Identifies high-risk patients for in-hospital mortality with suspected infection outside the ICU.
Takes into consideration altered mental state, systolic BP <100 and RR >22. A score of >=2 indicates heightened risk of mortality

Question 12

How do we interpret NEWS scores?

Answer 12

Low risk (aggregate score 1 to 4) – prompt assessment by ward nurse to decide on change to frequency of monitoring or escalation of clinical care.

Low to medium risk (score of 3 in any single parameter) – urgent review by ward-based doctor to determine cause and to decide on change to frequency of monitoring or escalation of clinical care.

Medium risk (aggregate score 5 to 6) – urgent review by ward-based doctor or acute team nurse to decide on escalation to critical care team.

High risk (aggregate score of 7 or over) – emergency assessment by critical care team, usually leading to patient transfer to higher-dependency care area.

Question 13

Sepsis red flags?

Answer 13

Altered mental state e.g. acute confusion state, only responding to voice/pain, unrepsonsive
RR >25
Requires oxygen to keep sats >=92
Systolic BP <90 (or >40 less than normal)
HR >130
Oliguria, AKI or anuria for 12-18 hours
Lactate >2
Purpuric rash, mottled, ashen, cyanotic skin
Recent chemotherapy in last 2-3 weeks

Question 14

How fast should there sepsis 6 be done?

Answer 14

Within the first hour of diagnosing the pt with sepsis! This is the golden hour concept
It has been shown in studies that every hour delay in antiotbiocis for septic shock increases mortality

Question 15

What is the sepsis 6?

Answer 15

Oxygen to maintain sats >=94%
Blood cultures
IV antibiotics
IV fluids
Check lactate
Monitor urine output

Question 16

What fluids should be used in sepsis?

Answer 16

A bolus of 500ml crystalloids over less than 15 minutes regardless of the bp

Question 17

How do we interpret lactate results in sepiss?

Answer 17

Lactate indicates tissue hypoxia and anaerobic metabolism
It should improve with treatment so we can monitor it. If after antibiotics its still very high then this has a poor prognosis

Question 18

What is normal urine output?

Answer 18

> 0.5ml/kg/hour

Question 19

Why is it not always suitable to use a catheter to monitor urine output in sepsis?

Answer 19

As its a major source of infection itself

Question 20

What additional investigations should you do in a sepsis picture?

Answer 20

Bloods - FBC, CRP, U&Es, LFTs, clotting screen
Urinalysis and culture
CXR
Any other dependant on presentation e.g. skin swabs

Question 21

Complications of sepsis?

Answer 21

Death
Organ dysfunction and failure
Recurrent and secondary infection
Coagulopathy -> DIC or thromboembolism
Neurological sequelae
Cognitive and functional disability
Psychological seqelae
Loss of fingers/toes/limbs
Major impact on life and ability to work

Question 22

What is post-sepsis syndrome?

Answer 22

Long term effects after severe sepsis that commonly last 6-8 months but can go on for years in some
Can include lethargy, muscle weakness, poor appetite, swollen limbs, joint pains, insomnia, hair loss, repeated infections, SOB, changes in vision, changes in sensation in limbs, sweating, reduced kidney function, dry skin a nd nails, insomnia and mental changes

Question 23

What is the principle of source control in the management of sepsis?

Answer 23

The goal is to eliminate the source of infection and control ongoing contamination and restore premorbid anatomy and function
This may include draining purulent collections, debridement, removing obstructions

Question 24

What is antimicrobial resistance?

Answer 24

The loss of antimicrobial effectiveness
This evolves naturally but the process is accelerated by the inappropriate and incorrect use of antimicrobials q

Question 25

What are the principles of antimicrobial stewardship?

Answer 25

AMS is an organisation or healthcare system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness.
• document in pt notes the decisions related to antimicrobial use and reasons for prescribing or not prescribing it
• In hospital take a microbiological sample before initiating antimicrobials. Consider this in primary care. Review the antimicrobial choice when results are available
• Follow guidelines on prescribing the shortest effective course and most appropriate antibiotic, dose and route of administration.
- limit empiric antibiotic therapy to life-threatening situations
- know the local antibiotic resistance patterns
• When on IV antimicrobials always review within 48 hours and consider stepping down to oral whenever possible
• Educate pt about benefits and harms, to only take them when recommended by a suitably qualified HCP, obtain antimicrobials from a HCP, take them as instructed and return any unused antimicrobials to a pharmacy for safe disposal