Sepsis

Question 1

What is sepsis?

Answer 1

Sepsis is characterised by a life-threatening organ dysfunction due to a dysregulated host response to infection.

Infections are an invasion of pathogenic microorganisms within tissue. Immunity within pregnancy is lowered.

Question 2

What are the types of sepsis shock?

Answer 2

• Hypovolaemia - severe dehydration to blood loss
• Cardiogenic - heart cannot pump enough blood to meet body needs
• Obstructive - blood flow to heart or major organs/vessels is blocked/reduced
• Distributive - low blood flow to vital organs due to systemic vasodilation

Each type of shock affects the body’s ability to deliver oxygen to tissues differently.

Question 3

List common signs and symptoms of sepsis.

Answer 3

• Diarrhoea
• Hypothermia
• Voiding
• Hypotension
• Tachycardia
• Increased O2 requirement
• Pyrexia
• Rigors
• Hyperlactatemia
• Rash
• Altered state of consciousness
• Decreased cap refill
• Abdominal pain and tenderness
• Abnormal FHR
• Tachypnoea
• Cyanosis
• Oedema
• Non-blanching rash
• Poor communication
• Not passing urine

These symptoms can vary widely among individuals and may indicate severe infection.

Question 4

What is the SEPSIS 6 protocol?

Answer 4

• Ensure senior clinician attends
• Administer high-flow oxygen if SpO2 <92%
• Monitor urine output and lactate
• Administer intravenous antibiotics and consider source control
• Administer intravenous fluids
• IV access and blood tests (blood cultures, lactate, FBC, U&E, CRP)

This protocol is a rapid response to suspected sepsis to improve patient outcomes.

Question 5

What are the four stages of shock?

Answer 5

• Initial
• Compensatory
• Progressive
• Refractory

Each stage represents a progression of the body’s response to inadequate blood flow and oxygen delivery.

Question 6

In the initial stage of shock, what occurs?

Answer 6

Reduced fluid, lower BP, reduced O2 to tissues, cold extremities.

This stage marks the body’s first response to shock.

Question 7

What occurs during the compensatory stage of shock?

Answer 7

Prioritizes blood to vital organs, vasoconstriction to kidneys, skin, GI tract, and lungs, BP lowers, reduced O2 to tissue, rise in ADH and adrenaline to try to increase BP.

The body attempts to compensate for the lack of blood flow.

Question 8

What happens in the progressive stage of shock?

Answer 8

Results in multi-system failure; compensatory mechanisms start to fail, BP continues to fall, poor blood supply to coronary arteries, weak pulse, increased acidosis.

This stage indicates a critical condition that requires immediate intervention.

Question 9

What occurs in the refractory stage of shock?

Answer 9

Multi-system failure, cell death, brain damage, death.

This is the final and most severe stage of shock.

Question 10

What actions should be completed within one hour according to the Sepsis Six protocol?

Answer 10

• Ensure senior clinician attends
• Administer oxygen if required
• Obtain IV access and take bloods
• Give IV antibiotics
• Administer IV fluids
• Monitor patient

Timely intervention is critical in managing sepsis effectively.

Question 11

True or False: Immunosuppressed individuals are at greater risk for developing sepsis.

Answer 11

True

Other risk factors also include being part of black/ethnic minority groups.

Question 12

Fill in the blank: Sepsis is characterized by ______ dysfunction due to a dysregulated host response to infection.

Answer 12

[organ]

Organ dysfunction is a key feature of sepsis.

Question 13

What are risk factors for development of sepsis?

Answer 13

PROM, infection at home, immunosuppressed, black/ethnic groups, anemia, GBS, surgery, UTI, diabetes

Question 14

What bloods do we take for suspected sepsis and why?

Answer 14

FBC - see how WBC fight infection
U&E - liver and kidney function to ensure o2 circulation
Blood cultures
Lactate - understand if there is lack of o2

Question 15

What are neonatal risk factors for developing sepsis?

Answer 15

Maternal sepsis
Sig mec
IOL
Maternal pyrexia
Preterm labour
PROM
Multiple VE
Chorioamnionitis
Maternal UTI
Maternal GBS

Question 16

What is neonatal sepsis caused by?

Answer 16

Mostly caused by GBS, but is caused by infection and bacteria

Question 17

Signs of sepsis in the newborn?

Answer 17

Not interested in feeding especially in a baby previously feeding well
Not waking for feeds
Vomiting: Note type, colour & volume
Loose stools
Abdominal Distension
Poor weight gain
Jaundice within 24 hours
Hypoglycaemia or Hyperglycaemia
Excessive bleeding
Poor temperature control
temperature recorded above 38oC.
temperature below 36.0oC
Tachypnoea >60 breaths / minute change or slow and laboured <30 breaths /minute.
Noisy breathing / Grunting
Cough
Discharge from nose
Apnoea
Recession-chest, sub clavicular, rib flaring
Irritability
Lethargy
Poor sucking reflex
Unresponsive
High pitched cry
Jittery
Bulging fontanelle
Hypo/hypertonic
Seizures