Sepsis

Question 1

Define sepsis.

Answer 1

Sepsis is characterised by a life-threatening organ dysfunction due to a dysregulated host response to infection.

Question 2

Define septic shock.

Answer 2

Septic shock is a subset of sepsis where particularly profound circulatory, cellular and metabolic abnormalities substantially increase mortality.

Question 3

What are the risk factors for sepsis (i.e. who is most at risk)?

Answer 3

• The very young (<1) and older adults (>75) or people who are very frail.
• People who have impaired immune systems because of illness or drugs.
• Women who are pregnant, have given birth or had a termination of pregnancy or miscarriage in the past 6 weeks are in a high-risk group for sepsis.
• Neonates

Question 4

What are the criteria in the qSOFA score?

Answer 4

• Respiratory rate of 22/min or greater.
• Altered mentation (GCS <15)
• Systolic BP of ≤100mmHg

Question 5

Describe RED FLAG SEPSIS.

Answer 5

• AVPU = V, P or U (changed from normal)
• Acute confusion
• RR ≥ 25/min
• Needs O₂ to maintain SpO₂ ≥92% (88% in COPD)
• HR >130bpm
• Systolic BP ≤90mmHg (or drop >40 from normal)
• Not passed urine in the last 18 hours / UO <0.5mL/kg/hr
• Non-blanching rash, mottled / ashen / cyanotic
• Recent chemotherapy (last 6 weeks)
• Red flag sepsis (RFS) identifies patients likely to be at high risk of deterioration. Act immediately.

Question 6

If a patient is identified by red flag sepsis, what should you do?

Answer 6

• Act immediately.
• Actions will vary according to clinical setting:
  
  • In GP, might call 999 and communicate using the term ‘red flag sepsis’.
  • In hospital, this will be to ensure prompt delivery of the sepsis 6.

Question 7

How is septic shock identified?

Answer 7

• Sepsis and (despite adequate volume resuscitation) persistent hypotension requiring vasopressors to maintain Mean Arterial Pressure (MAP) ≥65mmHg, and lactate ≥2mmol/L.
• This is usually a trigger to call critical care.
• A patient who is:
  
  • Hypotensive (RFS criterion = SBP <90mmHg)
  • AND who has a lactate >2mmol/L following fluid resuscitation

Question 8

What are the sepsis 6?

Answer 8

1. Give O₂ therapy to maintain sats >94%
2. Blood cultures
3. IV ABx
4. Fluid challenge
5. Measure lactate (serial)
6. Mesure urine output

Question 9

Describe the components of the ongoing management of sepsis.

Answer 9

• Fluid management
• Vasoactive drugs
• Antimicrobial therapy
• Respiratory support
• Renal therapy
• Nutrition
• Communication