Sepsis

Question 1

What are the risk factors for sepsis?

Answer 1

Retained products of conception
Manual removal of placenta/placental products
Prolonged rupture of membranes
C/S
Premature labour
Maternal obesity
Water birth
Diabetes
Impaired immunity
Cervical suture
Following an invasive intrauterine procedure (including amniocentesis or cvs)

Question 2

What are the symptoms of sepsis?

Answer 2

Diarrhoea
Vomiting
Abdominal pain
rash
Sore throat
Sputum
Vaginal discharge
Wound infection
Dysuria low urine output (<0.5ml/kg/hr)

Question 3

What are the clinical signs of sepsis?

Answer 3

Raised resp rate >20
Tachycardia >100
High or low temp >38 degrees or <36
hypotension (systolic BP <90mmHg)
low oxygen sats <95%
poor peripheral perfusion (delayed capillary refill of >2 seconds)
skin clamminess
Rash or mottling of the skin
Confusion or altered mental state

Question 4

What are signs of severe sepsis

Answer 4

Lactate >2mmol/L (lactate of >4 and/or metabolic acidosis PH <7.35 has a poor prognosis)
Systolic BP <90mmHg
Urine output <0.5mls/kg/hr
Creatinine >176umol/L
Platelets <100
INR >1.5
Altered mental state/confusion/unconscious
Elevated CRP

Question 5

What is maternal sepsis defined as?

Answer 5

Organ dysfunction resulting from infection during pregnancy, post abortion, or during the puerperium. It is a life threatening condition and should not be classed as ‘just an infection’

Question 6

What is the sepsis six pathway?

Answer 6

Administer oxygen - aim to keep sats >94%
Take blood cultures - consider csf, urine, sputum, call radiologist if needed chest x ray.
Give IV antibiotics
Give IV fluids - if hypotensive/ lactate >2mmol/l, 500ml stat, do not exceed 30ml/kg.
Check serial lactates - if lactate <4mmol/l call critical care.
Measure urine output/urinalysis

Question 7

What is SIRS?

Answer 7

Systemic inflammatory response syndrome

Question 8

What does SIRS affect?

Answer 8

temperature <36 degrees or >38
Pulse >90
Respirations >20
Blood pressure
Whereas sepsis affects multiple body systems
Other lab test results which suggest a systemic response is
WCC <4 or >12

Question 9

Sepsis is SIRS + ……

Answer 9

An identifiable (or suspected) pathogenic organism

Question 10

What is severe sepsis?

Answer 10

Sepsis with organ dysfunction, hypoperfusion (reduced amount of blood flow) or hypotension (low blood pressure)

Question 11

What is septic shock?

Answer 11

sepsis with refractory hypotension despite despite adequate fluid resuscitation

Question 12

When should the sepsis six actions be completed within?

Answer 12

An hour (the golden hour)

Question 13

What should also be considered with sepsis?

Answer 13

Blood glucose control
TED’s and LMWH
Identify source of sepsis and control