Sepsis

Question 1

What is sepsis?

Answer 1

Life threatening organ dysfunction caused by abnormal and uncontrolled host response to infection.

Question 2

What is the criteria for sepsis diagnosis?

Answer 2

Presence of known or suspected infection
Clinical features of organ dysfunction
- Calcular a SOFA score to quantify the level of organ dysfunction - 2 or more indicates sepsis

Question 3

What does the qSOFA score include?

Answer 3

Respiratory rate of 22 or more
Altered mental state
Systolic BP 100mmHg or less

Score of 2 or more should be investigated and managed for sepsis

Question 4

How would you manage a patient with suspected sepsis?

Answer 4

Complete sepsis six within one hour:

Blood cultures - before ABX (+CXR or urinalysis to determine underlying cause if appropriate)
Urine output measurement - catheterise, start input/output chart aim for >0.5ml/kg/hour
Fluid resuscitation - 500ml 0.9% NaCl bolus stat dose over 15 minutes, reassess and repeat if necessary
Antibiotics - broad spectrum IV 1g meropenem
Lactate - serum measurement (ABG or VBG +other bloods - FBC, U&E, LFT, Clotting, CRP, glucose)
Oxygen - high flow 100% 15L O2 via a non-rebreathable mask aiming for target SaO2 - 94-98% (COPD - 88-92)

Hourly observation

Consider ICU, RRT, ventilator support

Question 5

What investigations to assess the source of infection?

Answer 5

Urine dip/culture
Swabs of wounds
Operative site assessment (CT/USS)
CXR
CSF fluid sample (LP)
Stool culture

Question 6

When should you escalate sepsis patient?

Answer 6

Evidence of septic shock: BP , 90/60
Lactate > 4mmol
Failure to improve on initial management

Question 7

What are the common sources of infection in surgical patients?

Answer 7

Chest infection
Cut - wound infetion
Catheter - UTI
Collections - abscesses within abdomen, pelvic or subphrenic
Calves - DVT
Cannula - Infeciton
Central line - infection

Question 8

What is septic shock?

Answer 8

sepsis with hypotension despite adequate fluid resuscitation requiring the use of inotropic agents to maintain normal systolic BP

Question 9

Normal SaO2
Normal BP
Normal lactate
Normal urine output

Answer 9

> 96%. <94 is bad (88-92 in COPD)
120/80, 140/90 is high, 90/60 is low
0.5-1.0mmol/L, <2 is normal for ill patient. 2-4mmol/L is raised)
0.5ml/kg/h (oliguria is <0.5)