Sepsis

Question 1

What is sepsis?

Answer 1

Sepsis is life-threatening organ dysfunction caused by an abnormal and uncontrolled host response to infection.

Question 2

What is the overall mortality rate of sepsis?

Answer 2

30-40%, making it the leading cause of death in intensive care units.

Question 3

What is the increased risk of mortality for any patient admitted to the hospital with sepsis?

Answer 3

10% increased risk of mortality.

Question 4

What are the two criteria required for a diagnosis of sepsis?

Answer 4

1. Presence of a known or suspected infection.
2. Clinical features of organ dysfunction.

Question 5

What score is used to quantify the level of organ dysfunction in sepsis?

Answer 5

The SOFA score (Sequential Organ Failure Assessment).

Question 6

What SOFA score indicates sepsis in a patient with a known or suspected infection?

Answer 6

SOFA score ≥2.

Question 7

Why was the previous sepsis criteria problematic?

Answer 7

It identified many hospital patients who never developed infection or adverse outcomes and missed 1 in 8 ICU patients with infection and organ failure.

Question 8

What is the qSOFA score used for?

Answer 8

Rapid bedside assessment of potential sepsis based purely on clinical signs.

Question 9

What are the three criteria for the qSOFA score?

Answer 9

1. Respiratory rate ≥22/min (1 point).
2. Altered mental state (1 point).
3. Systolic blood pressure ≤100 mmHg (1 point).

Question 10

What qSOFA score suggests the need for investigation and management of sepsis?

Answer 10

qSOFA score ≥2.

Question 11

What is the ‘Sepsis Six,’ and within what time frame should it be completed?

Answer 11

Six immediate management steps to be completed within 1 hour of diagnosing sepsis.

Question 12

What is the first step of the Sepsis Six?

Answer 12

Administer 15L oxygen via a non-rebreathable mask, aiming for saturations of 94-98% (88-92% in chronic retainers).

Question 13

What is the second step of the Sepsis Six?

Answer 13

Administer 500-1000mL IV fluid bolus, followed by reassessment of fluid status.

Question 14

What is the third step of the Sepsis Six?

Answer 14

Take blood cultures prior to administering antibiotics, along with other relevant site-specific cultures.

Question 15

What is the fourth step of the Sepsis Six?

Answer 15

Start empirical IV antibiotics based on local guidelines, switching to targeted therapy when sensitivities are available.

Question 16

What is the fifth step of the Sepsis Six?

Answer 16

Perform routine blood tests, including FBC, U&E, LFTs, clotting, CRP, and glucose. Assess lactate from a blood gas.

Question 17

What is the sixth step of the Sepsis Six?

Answer 17

Monitor urine output, catheterizing if necessary, and aim for >0.5 mL/kg/hour.

Question 18

What additional investigations might be necessary to identify the infection source in sepsis?

Answer 18

1. Urine dip ± culture.
2. Chest X-ray (CXR).
3. Swabs (e.g., surgical wounds).
4. Operative site assessment (CT/US).
5. Cerebrospinal fluid sample (via LP).
6. Stool culture.

Question 19

When should the intensive care or clinical outreach team be involved in sepsis management?

Answer 19

1. Evidence of septic shock.
2. Lactate >4.0 mmol/L.
3. Failure to improve with initial management.

Question 20

What mnemonic can help remember common sources of infection in surgical patients?

Answer 20

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).

Question 21

How is septic shock defined?

Answer 21

Sepsis with hypotension, despite adequate fluid resuscitation, or requiring inotropic agents to maintain a normal systolic blood pressure.

Question 22

What is the usual management of septic shock?

Answer 22

1. Aggressive fluid resuscitation.
2. Antibiotic therapy.
3. Involvement of the critical care team.
4. Use of inotropes to maintain organ perfusion.

Question 23

What are the key points in sepsis management?

Answer 23

1. Sepsis is life-threatening organ dysfunction caused by infection.
2. Diagnosis requires known/suspected infection with organ dysfunction.
3. Early identification and management are essential.
4. The Sepsis Six aids in initial investigation and management.