Sepsis

Question 1

What is sepsis?

Answer 1

Sepsis is caused by the body mounting a systemic inflammatory response to infection

Question 2

What are the high-risk criteria for sepsis?

Answer 2

• Altered mental state
• HR >130 bpm
• RR - 25 or more or new need for 40% o2 to maintain SaO2 >92%
• Systolic BP <90mmHg
• Anuria/oliguria
• mottled/ashen appearance
• Cyanosis of skin, lips or tongue
• Non-blanching skin rash

Question 3

What investigations do you carry out?

Answer 3

ABGs - glucose and lactate
Blood culture
FBC
CRP
Urea and electrolytes
Creatinine
Clotting screen

Question 4

What is immediate treatment?

Answer 4

1) IV antibiotics (within 1 hour if any high-risk criteria)

2) IV fluid bolus without delay (within 1 hour if any high-risk criteria)

Question 5

What are the medium-risk criteria for sepsis?

Answer 5

• altered behaviour from collateral history
• impaired immune system
• trauma, surgery, invasive procedure in last 6 weeks
• RR 21-4
• HR 91-130
• Sys BP 91-100 mmHg
• anuria 12-18 hrs
• temp <36
• Signs of potential infection

Question 6

Why is lactate measured?

Answer 6

Lactate accumulates in the blood as a result of anaerobic respiration, which is a pathological physiological response to lack of oxygen reaching the tissues

Question 7

Why are U&Es measured?

Answer 7

Kidneys are often affected early in sepsis, and because of low blood flow in renal medulla, they are particularly sensitive to ischaemic damage

Question 8

Why is a clotting screen done?

Answer 8

In severe sepsis, there is dysregulation of coagulation system