Sepsis

Question 1

Define sepsis?

Answer 1

• Organ dysfunction due to dysregulated response to infection
• Suspected infection + 2 of the following:
  
  • Hypotension (SBP <100)
  • Tachypnoea (>=22 breaths/min)
  • Altered mental status (GCS <15)

Question 2

Describe a quantifying score for mortality in suspected infection/sepsis?

Answer 2

• qSOFA score
  
  • Score > = 2
    
    • RR > 22/min
    • Altered mental state
    • Systolic BP < 100mmHg
  • Full SOFA score used in ICU

Question 3

Name some red flag criteria within sepsis?

Answer 3

• RR > 25
• HR > 130
• SBP < 90
• Lactate > 2
• Reduced GCS
• Non-blanching rash

Question 4

Describe the management of sepsis?

Answer 4

• Cause of patient’s sepsis should be treated (eg UTI)
• Sepsis 6
  
  • Administer high flow oxygen (SpO2 > 94%)
  • Take blood cultures
  • Give broad spectrum antibiotics
  • Give IV fluid challenges (500ml crystalloid over 10 mins)
  • Measure serum lactate
  • Measure hourly urine output

Question 5

Describ septic shock?

Answer 5

• Sepsis with underlying cellular/metabolic abnormalities associated with increased mortality
• Persistence of the following symptoms despite fluid resuscitation:
  
  • Hypotension requiring vasopressors to maintain MAP>65
  • Serum lactate >2mmol/L

Question 6

Describe neutropaenic sepsis?

Answer 6

• Complication of chemo
• Neutrophil count < 0.5x10⁹ in patient with anticancer treatment + 1 of following:
  
  • Temp > 38^oC
  • Signs/symptoms of sepsis

Question 7

Describe prophylaxis for neutropaenic sepsis?

Answer 7

Patients with neutrophils < 0.5x10⁹ = Fluoroquinolone

Question 8

Describe the management of neutropaenic sepsis?

Answer 8

• Piperacillin + Tazobactam
• If febrile/unwell after 48 hrs -> Meropenem +/- vancomycin

Question 9

Describe a good severity biomarker for sepsis?

Answer 9

• Serum lactate
• Lactate > 8 indicates high mortality

Question 10

Name some mimics for sepsis?

Answer 10

• Pancreatitis
• Drug reactions
• Carcinoid syndrome
• IBD, SLE, RA

Question 11

Describe neutropenic sepsis?

Answer 11

• Complication of chemotherapy
• Neutrophil count <0.5 x10⁹ + 1 of the following:
  
  • Temperature >38
  • Signs of sepsis

Question 12

Describe the prophylaxis for neutropaenic sepsis?

Answer 12

• If you expect a patient to have a neutrophil count < 0.5x10⁹:
  
  • Fluoroquinolone antibiotic - Ciprofloxacin

Question 13

Describe the management of neutropenic sepsis?

Answer 13

• Piperacillin + taxobactan immediately
• If febrile/unwell after 48 hours:
  
  • Try Meropenem
• If febrile/unwell after 7 days:
  
  • Test for fungal infection

Question 14

What can be used to determine the severity of sepsis?

Answer 14

• NEWS2
  
  • National early warning score 2
• Score between 0 and 20
• NEWS >5 = Urgent clinical review
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