Sepsis

Question 1

What is the definition of sepsis?

Answer 1

The presence of infection with systemic manifestations e.g. pyrexia, pallor, tachycardia and raised inflammatory markers

Question 2

What is sever sepsis?

Answer 2

Sepsis with sepsis induced organ dysfunction or tissue hypoperfusion

Question 3

What are the signs of severe sepsis?

Answer 3

Raised lactate above 1mmol/L, raised bilirubin above 70micromol/L, INR above 1.5, low arterial oxygen concentration and urine output of less than 0.5ml/kg/h

Question 4

Define septic shock.

Answer 4

Sepsis induced hypotension persisting despite fluid resuscitation. (MAP of 70mmHg and systolic bp less than 90mmHg)

Question 5

According to NICE, which patients are at a moderate to high risk of developing sepsis?

Answer 5

Those with impaired immune system, new onset of altered behaviour/mental state, HR of 91-130bpm, no urine in 12-18 hours, temperature less than 36, systolic bp of 91-100mmHg, 21-24 breaths/min, trauma, surgery or invasive procedure in last 6 weeks.

Question 6

According to NICE, which patients are at high risk of developing sepsis?

Answer 6

Those with objective evidence of altered mental state, more than 25 breaths/min, oxygen is required to maintain their sats above 92%, systolic bp more than 40mmHg below normal, no urine for 18 hours, non-blanching skin rash, mottled appearance, HR above 130bpm

Question 7

Name the two inflammatory cytokines released during sepsis.

Answer 7

Interleukin 1 & 6 and TNF

Question 8

What does the release of nitric oxide during sepsis lead to?

Answer 8

Vasodilation, hypotension and reduced consciousness.

Question 9

What is the mortality rate for sepsis?

Answer 9

15%

Question 10

What is the mortality rate for severe sepsis?

Answer 10

20%

Question 11

What is the mortality rate for septic shock?

Answer 11

45%

Question 12

List the risk factors for sepsis.

Answer 12

Recent surgery, central lines, urinary catheters, immunocompromised eg cancer and HIV, neonates and infants and chronic disease

Question 13

List the sepsis 6

Answer 13

1. Administer oxygen
2. Take blood cultures
3. Broad spectrum antibiotics (max dose and frequency)
4. Fluid resuscitation (0.9% NaCl infusion as fast as possible)
5. Measure lactate
6. Monitor urine output

Question 14

What is urine output an indicator of?

Answer 14

Tissue perfusion and kidney function

Question 15

What flow rate of oxygen should be administered to sepsis patients?

Answer 15

24L/minute

Question 16

What are the symptoms of sepsis?

Answer 16

Fever/vomiting, pale/mottled skin, fast breathing/breathless, confused, skin rash, shivering, cold hands/feet, limb, joint and muscle pain and fatigue