Sepsis Flashcards
What is sepsis?
Sepsis is life-threatening organ dysfunction caused by an abnormal and uncontrolled host response to infection.
What is the overall mortality rate of sepsis?
30-40%, making it the leading cause of death in intensive care units.
What is the increased risk of mortality for any patient admitted to the hospital with sepsis?
10% increased risk of mortality.
What are the two criteria required for a diagnosis of sepsis?
- Presence of a known or suspected infection.
- Clinical features of organ dysfunction.
What score is used to quantify the level of organ dysfunction in sepsis?
The SOFA score (Sequential Organ Failure Assessment).
What SOFA score indicates sepsis in a patient with a known or suspected infection?
SOFA score ≥2.
Why was the previous sepsis criteria problematic?
It identified many hospital patients who never developed infection or adverse outcomes and missed 1 in 8 ICU patients with infection and organ failure.
What is the qSOFA score used for?
Rapid bedside assessment of potential sepsis based purely on clinical signs.
What are the three criteria for the qSOFA score?
- Respiratory rate ≥22/min (1 point).
- Altered mental state (1 point).
- Systolic blood pressure ≤100 mmHg (1 point).
What qSOFA score suggests the need for investigation and management of sepsis?
qSOFA score ≥2.
What is the ‘Sepsis Six,’ and within what time frame should it be completed?
Six immediate management steps to be completed within 1 hour of diagnosing sepsis.
What is the first step of the Sepsis Six?
Administer 15L oxygen via a non-rebreathable mask, aiming for saturations of 94-98% (88-92% in chronic retainers).
What is the second step of the Sepsis Six?
Administer 500-1000mL IV fluid bolus, followed by reassessment of fluid status.
What is the third step of the Sepsis Six?
Take blood cultures prior to administering antibiotics, along with other relevant site-specific cultures.
What is the fourth step of the Sepsis Six?
Start empirical IV antibiotics based on local guidelines, switching to targeted therapy when sensitivities are available.
What is the fifth step of the Sepsis Six?
Perform routine blood tests, including FBC, U&E, LFTs, clotting, CRP, and glucose. Assess lactate from a blood gas.
What is the sixth step of the Sepsis Six?
Monitor urine output, catheterizing if necessary, and aim for >0.5 mL/kg/hour.
What additional investigations might be necessary to identify the infection source in sepsis?
- Urine dip ± culture.
- Chest X-ray (CXR).
- Swabs (e.g., surgical wounds).
- Operative site assessment (CT/US).
- Cerebrospinal fluid sample (via LP).
- Stool culture.
When should the intensive care or clinical outreach team be involved in sepsis management?
- Evidence of septic shock.
- Lactate >4.0 mmol/L.
- Failure to improve with initial management.
What mnemonic can help remember common sources of infection in surgical patients?
The Seven C’s:
1. Chest (infection).
2. Cut (wound infection).
3. Catheter (UTI).
4. Collections (abdominal/pelvic).
5. Calves (DVT).
6. Cannula (infection).
7. Central line (infection).
How is septic shock defined?
Sepsis with hypotension, despite adequate fluid resuscitation, or requiring inotropic agents to maintain a normal systolic blood pressure.
What is the usual management of septic shock?
- Aggressive fluid resuscitation.
- Antibiotic therapy.
- Involvement of the critical care team.
- Use of inotropes to maintain organ perfusion.
What are the key points in sepsis management?
- Sepsis is life-threatening organ dysfunction caused by infection.
- Diagnosis requires known/suspected infection with organ dysfunction.
- Early identification and management are essential.
- The Sepsis Six aids in initial investigation and management.
