Sepsis Flashcards
Q: What is the importance of early recognition and treatment of sepsis?
A: Early recognition and treatment of sepsis significantly reduce mortality and improve patient outcomes by preventing deterioration and organ failure.
Q: What tool is used to identify patients at risk of sepsis in hospitals?
A: NEWS 2
Q: What are the high-risk (‘Red Flag’) criteria for sepsis?
A:
NEWS2 score ≥7 or NEWS2 5-6 with one of the following:
Any single NEWS2 parameter scoring 3.
Mottled or ashen skin.
Non-blanching rash.
Cyanosis of skin, lips, or tongue.
Serum lactate >2 mmol/L.
Acute kidney injury (AKI).
Q: What are the moderate-risk (‘Amber Flag’) criteria for sepsis?
A:
NEWS2 score of 5 or 6 without high-risk features.
Clinical signs like mottled skin, non-blanching rash, cyanosis, or deterioration.
Q: What are the vital signs and assessments for recognizing sepsis?
A:
Respiratory rate >25 breaths/min.
Heart rate >130 beats/min.
Blood pressure: Systolic ≤90 mmHg or drop >40 mmHg.
Temperature: High or low, but not always present.
Oxygen saturation: Low SpO₂ levels.
Mental state: New confusion or reduced consciousness.
Urine output: Reduced or absent.
Q: Why is respiratory rate an important sign in sepsis?
A: Increased respiratory rate is an early sign of critical illness due to tissue hypoxia and lactic acidosis, which can indicate sepsis.
Q: How does sepsis affect heart rate and blood pressure?
A:
Sepsis causes vasodilation and capillary leakage, leading to hypovolemia.
This triggers the sympathetic nervous system to increase heart rate to maintain organ perfusion.
Blood pressure may drop due to reduced vascular resistance.
Q: How is oxygen saturation used in identifying sepsis?
A:
Sepsis causes hypoxia, so peripheral oxygen saturation should be monitored.
In cases of poor circulation, an arterial blood gas sample may be necessary.
Q: What is the significance of reduced urine output in sepsis?
A:
Oliguria (<0.5 mL/kg/hr) indicates poor kidney perfusion and risk of acute kidney injury (AKI).
Reduced urine output suggests compromised cardiac output and requires urgent action.
Q: What skin changes are associated with sepsis?
A:
Mottled or ashen skin.
Non-blanching purpuric rash.
Cyanosis of lips, tongue, or extremities.
Q: What mental state changes are signs of sepsis?
A:
New confusion or disorientation.
Reduced consciousness (assessed using the ACVPU scale).
Behavioral changes in patients with dementia or learning disabilities.
Q: What is neutropenic sepsis, and how is it managed?
A:
Neutropenic sepsis occurs when neutrophils drop below 0.5 x 10⁹/L after chemotherapy.
Requires urgent IV antibiotics within 1 hour of hospital arrival.
Q: Why is serum lactate measurement important in sepsis?
A:
Elevated serum lactate (≥2 mmol/L) indicates tissue hypoxia and metabolic distress.
A lactate level >4 mmol/L is linked to a 38% risk of death.
Q: How should patients with suspected sepsis be monitored?
A:
Perform continuous or 30-minute interval observations.
Use structured assessments like NEWS2 for patients over 16 years.
Follow local guidelines for pediatric and pregnant patients.
Q: What role does family or carers’ input play in recognizing sepsis?
A:
Family or carers can help identify subtle behavioral changes or deteriorations in patients with cognitive impairments, aiding early sepsis detection.
Q: What is the Sepsis Six bundle, and why is it important?
A:
The Sepsis Six is a set of urgent actions to be completed within 1 hour of identifying sepsis:
Administer oxygen to maintain SpO₂ >94%.
Take blood cultures.
Administer IV antibiotics.
Measure serum lactate and check for AKI.
Start IV fluids to correct hypotension.
Monitor urine output.
It improves survival rates by initiating early treatment.
Q: How does sepsis present differently in vulnerable groups?
A:
Older adults may show confusion or behavioral changes instead of fever.
Children can present with irritability, lethargy, or reduced feeding.
People with learning disabilities or cognitive impairment may have subtle changes in mood or function.
Use information from carers and consider health passports for tailored care.
Q: How is point-of-care lactate testing used in sepsis detection?
A:
Rapid bedside lactate testing allows early detection of tissue hypoxia.
It can be done via a fingertip blood sample in ambulances and emergency departments.
A lactate level of ≥2 mmol/L signals the need for urgent action.
Q: Why is a chest X-ray important in patients with suspected sepsis?
A:
A chest X-ray helps identify respiratory infections, such as pneumonia.
It supports diagnosis when the source of infection is unclear.
Recommended when sepsis is suspected with respiratory symptoms.
Q: What safety measures should be taken for patients with reduced consciousness due to sepsis?
A:
Use the ACVPU scale to assess consciousness.
Place the patient in the recovery position if unresponsive.
Raise bed rails if appropriate to prevent falls, following risk assessments.
Monitor closely for airway obstruction and aspiration risk.
Q: What is the Sepsis Six care bundle, and why is it important?
A:
A set of six key interventions to be completed within 1 hour of sepsis identification to improve survival.
Senior clinician review to confirm diagnosis and guide treatment.
Administer oxygen if required.
Obtain IV access and take bloods (including cultures, lactate).
Give IV antibiotics immediately.
Start IV fluids to correct hypovolemia.
Monitor NEWS2, urine output, and lactate.
Q: Why must a senior clinician assess the patient as part of the Sepsis Six?
A:
To differentiate sepsis from similar conditions (e.g., pancreatitis, dehydration).
To guide the most appropriate treatment and antibiotic selection.
Q: When and how should oxygen be administered in sepsis?
A:
15 L/min via a non-rebreathing mask for most patients.
Aim for oxygen saturation of 94–98% or 88–92% in chronic lung disease.
Oxygen must be prescribed as soon as possible.
Q: What blood tests are essential in sepsis management?
A:
Blood cultures before antibiotics (if possible).
Full blood count (FBC), urea and electrolytes (U&E), creatinine, C-reactive protein (CRP).
Lactate levels and blood gas analysis.
Q: Why is monitoring serum lactate critical in sepsis management?
A:
Elevated lactate (>2 mmol/L) indicates tissue hypoxia.
Lactate >4 mmol/L signals high mortality risk and requires urgent fluid resuscitation.
Q: What is the recommended approach to IV fluid resuscitation in sepsis?
A:
500 mL bolus of crystalloid over 5 minutes.
Repeat boluses up to 20 mL/kg if necessary.
Monitor for fluid overload in patients with heart or kidney disease.
Q: How should antibiotic therapy be managed in sepsis?
A:
IV broad-spectrum antibiotics within 1 hour of diagnosis.
Adjust antibiotics based on microbiology results and local policy.
Review antibiotic therapy at 24, 48, and 72 hours to prevent antimicrobial resistance.
Q: How should urine output be monitored in sepsis patients?
A:
Measure urine output hourly to assess kidney perfusion.
Catheterization may be necessary but should be minimized to reduce infection risk.
Q: What additional tests can help identify the source of infection?
A:
Cultures from urine, sputum, or CSF.
Chest X-ray or imaging for suspected abscesses.
Surgical drainage if needed for source control.
Q: What is the role of NEWS2 in sepsis management?
A:
A score of ≥5 triggers a sepsis screen.
A score of ≥7 or any parameter scoring 3 requires urgent escalation.
Q: How should patients be monitored after initiating treatment for sepsis?
A:
Continuous or 30-minute interval vital sign monitoring.
Reassess lactate levels regularly.
Check for improvement in blood pressure, lactate reduction, and urine output.
Q: What is the process for escalating care in sepsis management?
A:
Call critical care if the patient remains unstable after initial treatment.
Escalate if NEWS2 increases, lactate remains elevated, or the patient is critically ill.
Q: What is Post-Sepsis Syndrome (PSS), and what are its symptoms?
A:
A condition after recovery from sepsis with symptoms lasting 6–18 months.
Physical: Fatigue, frequent illness, poor appetite, sleep problems.
Psychological: Anxiety, depression, PTSD, mood changes.
Q: How should antimicrobial resistance be managed in sepsis care?
A:
Review the need for IV antibiotics at 24, 48, and 72 hours.
Plan to switch to oral therapy when possible.
Follow local antibiotic stewardship policies.
Q: Why is source control critical in sepsis management?
A:
Identifying and eliminating the infection source prevents ongoing sepsis.
May involve surgical drainage of abscesses, removal of infected devices (e.g., catheters), or debridement of infected tissue.
Should be performed urgently alongside medical treatment.
Q: What is the correct procedure for obtaining blood cultures in sepsis?
A:
Take at least two sets of blood cultures from different sites before starting antibiotics.
Clean the skin with an alcohol-based solution to prevent contamination.
If necessary, draw from central lines but also obtain peripheral samples for accuracy.
Q: How is septic shock managed if hypotension persists after fluid resuscitation?
A:
Initiate vasopressors (e.g., norepinephrine) to maintain mean arterial pressure (MAP) ≥65 mmHg.
Continue to monitor lactate levels and organ function.
Consider transfer to intensive care for advanced support.
Q: Why is glycemic control important in sepsis management?
A:
Sepsis can cause hyperglycemia, increasing the risk of poor outcomes.
Aim to maintain blood glucose levels between 6–10 mmol/L.
Use insulin therapy carefully to avoid hypoglycemia.
Q: What is the role of the Multidisciplinary Team (MDT) in sepsis care?
A:
Involves collaboration between doctors, nurses, pharmacists, microbiologists, and critical care teams.
Ensures timely interventions like antibiotic review, source control, and critical care escalation.
Enhances comprehensive and patient-centered care.
Q: What is the clinical definition of sepsis?
A:
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. It can lead to septic shock, involving circulatory, cellular, and metabolic dysfunction with high mortality risk.
Q: Which populations are at increased risk of developing sepsis?
A:
Neonates and people over 75 years old.
Individuals with weakened immune systems.
Pregnant women.
People with chronic conditions (e.g., diabetes, cancer).
Those with learning disabilities.
Q: What are common causes of sepsis?
A:
Pneumonia (bacterial, viral, fungal)
Urinary tract infections (UTIs) and catheter-related infections
Intra-abdominal infections (appendicitis, perforated bowel)
Bloodstream infections (e.g., endocarditis)
Wound infections (surgical or trauma-related)
Skin/soft tissue infections (cellulitis, infected ulcers)
Q: How does sepsis develop (pathophysiology)?
A:
Overactive immune response releases cytokines and coagulation factors.
Leads to vasodilation and blood vessel leakage.
Causes hypotension, hypoperfusion, acidosis, and organ dysfunction.
Q: What are the signs and symptoms of sepsis?
A:
Slurred speech or confusion.
Extreme shivering, fever, or muscle pain.
No urine output for a day.
Severe breathlessness.
Skin that is mottled, pale, or discolored.
Feeling like you’re going to die.
Q: How does sepsis present differently in children?
A:
Atypical symptoms: irritability, lethargy, or reduced feeding.
Higher mortality due to immature immune systems.
Vaccinations (e.g., against meningitis) reduce risk.
Q: Why are older adults at higher risk for sepsis?
A:
Weakened immune system and frailty.
Presence of chronic illnesses (e.g., diabetes, liver disease).
Increased risk with malnutrition and reduced mobility.
Q: How does pregnancy increase the risk of sepsis?
A:
Vasodilation and increased blood volume lead to respiratory strain.
Risk of urinary tract infections due to urinary stasis.
Use MEOWS (Modified Early Obstetric Warning Score) for early detection.
Q: Why are immunosuppressed patients at high risk for sepsis?
A:
Weakened immune response from chemotherapy, radiotherapy, or long-term steroid use.
Neutropenic sepsis is a medical emergency requiring urgent IV antibiotics.
Vaccination (e.g., pneumococcal vaccine) is essential for prevention.
Q: How are people with learning disabilities more vulnerable to sepsis?
A:
Difficulty in recognizing or communicating symptoms.
Behavioral changes may mask sepsis signs.
Healthcare staff and carers need training for early detection.
Q: Why are diabetic patients at increased risk for sepsis?
A:
High blood glucose impairs immune function.
Poor wound healing increases infection risk.
Higher risk of acute kidney injury (AKI) during sepsis.
Participation in vaccination programs (e.g., flu shots) is critical.
Q: What global actions have been taken to address sepsis?
A:
In 2017, the World Health Assembly declared sepsis a global health priority.
World Sepsis Day (September 13) raises awareness.
National guidelines (e.g., NICE) emphasize early detection and management.
Q: What is Post-Sepsis Syndrome (PSS), and what are its symptoms?
A:
Occurs after sepsis recovery and can last 6–18 months.
Physical: Fatigue, frequent illness, sleep issues, poor appetite.
Psychological: Anxiety, depression, PTSD, nightmares.
Q: How can sepsis be prevented in high-risk groups?
A:
Maintain up-to-date vaccinations.
Promote good hygiene and infection control.
Regular monitoring of immunosuppressed and diabetic patients.
Educate carers and patients on early warning signs.
Q: How do Hospital-Associated Infections (HAIs) increase the risk of sepsis?
A:
Invasive devices (e.g., urinary catheters, central venous lines) can introduce infections.
Post-surgical wounds and prolonged hospital stays increase infection risk.
Poor hand hygiene and improper equipment handling contribute to HAIs.
Q: How does Antimicrobial Resistance (AMR) contribute to sepsis risk?
A:
Overuse and misuse of antibiotics lead to drug-resistant infections.
Resistant bacteria are harder to treat, increasing the risk of severe infections and sepsis.
Adherence to antibiotic stewardship programs helps prevent AMR.
Q: Why are invasive medical devices a risk factor for sepsis?
A:
Devices like ventilators, feeding tubes, and dialysis catheters can introduce bacteria.
Biofilms on devices protect bacteria from antibiotics.
Regular monitoring and timely removal reduce infection risk.
Q: What is the role of Early Warning Systems (EWS) in detecting sepsis?
A:
Tools like NEWS2 and MEOWS identify early signs of deterioration.
Prompt action based on these scores improves early detection and treatment.
Regular monitoring of vital signs is critical for timely intervention.
Q: Why are skin and soft tissue infections dangerous for vulnerable populations?
A:
Pressure ulcers, diabetic foot ulcers, and wounds can lead to infection.
Immobile, diabetic, and elderly patients require regular skin checks.
Early detection and treatment of skin issues prevent sepsis.
