Sepsis

Question 1

Define septic shock;

Answer 1

Severe sepsis with circulatory shock and signs of organ dysfunction or hypoperfusion

Question 2

qSOFA:

Answer 2

1) SBP ≤100 mmHg
2) Respiratory rate ≥22
3) Altered mental state

2 or more points at onset of infection points to prolonged ICU stay and greater risk of death

Question 3

The following are Red or Amber flag criteria for spesis:

• Respond only to voice
• Acutely confused
• SBP ≤90 (or drop of over 40)
• HR >130
• Respiratory rate ≥25

Answer 3

Red

Question 4

Other red flags for sepsis?

Answer 4

• need O2 to keep ≥92%
• Non-blanching rash, mottle/ashen
• cyanosed
• no urine in last 18 hours
• Lactate ≥2mmol/L
• Recent Chemotherapy

Question 5

The following are amber or red flags for sepsis?

o Relatives concerned about mental status
o Acute deterioration in functional ability
o Immunosuppressed
o Trauma/ surgery/ procedure in last 6 weeks
o Respiratory rate 21-24

Answer 5

Amber

Question 6

What are other Amber sepsis flags?

Answer 6

o	Systolic B.P 91-100 mmHg
o	Heart rate 91-130 OR new dysrhythmia
o	Not passed urine in last 12-18 hours
o	Temperature < 36ºC
o	Clinical signs of wound, device or skin infection

Question 7

If unable to maintain mean arterial pressure ≥65 mmHG and a serum lactate of >2mmol/L what is this classified as?

Answer 7

Septic shock

Question 8

What is the sepsis 6?

Answer 8

1) Oxygen - keep >94%, or aim for 88-92% if at risk if CO2 retention (COPD)
2) Take blood cultures
3) Give maximum dose of broad spectrum antibiotics as quickly as possible. E.g. Tazocin (tazobactam) or piperacillin
4) Give intravenous fluid challenges: If patients over 16 years need intravenous fluid resuscitation, use crystalloids that contain sodium in the range 130-154 mmol/litre with a bolus of 500 ml over less than 15 minutes.
5) Measure serum lactate (do so by taking a venous blood gas or an ABG)
6) Accurately measure hourly urine output

Question 9

when to suspected neutropenic sepsis?

Answer 9

1) A known cause for neutropenia (recent cancer treatment)
2) Presumed or confirmed infection
3) Temp >38 degrees
4) Respiratory rate ≥21

Question 10

What procedure puts people at risk of sepsis?

Answer 10

Splenectomy

Question 11

Organisms likely to cause sepsis in hyposplenism?

Answer 11

Strep pneumoniae
Haemophilus influenzae
Meningocci