Sepsis

Question 1

What is Sepsis

Answer 1

Sepsis is defined as life threatening organ dysfunction caused by a dis-regulated host response to infection

Question 2

What is septic shock

Answer 2

Septic shock is a more severe form of sepsis, in which circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality compared with sepsis alone

Question 3

What are the risk factors of sepsis?

Answer 3

Age > 65
Alcohol
Immunocompromise
Malignancy
Pregnancy
Diabetes
Recent surgery or invasive procedures

Question 4

What are the clinical features of sepsis?

Answer 4

• High or low temp
• Acute altered mental state
• Cyanosis
• Tachycardia
• Tachypnoea
• Signs associated with specific source of infection
• Poor cap refill, mottled skin, ashen appearance
• Decreased urine output

Question 5

What is the differential diagnosis of Sepsis

Answer 5

• Myocarditis
• Pericarditis
• MI
• Pulmonary Embolism
• Acute Pancreatitis
• Leukemia
• Drug induced fever & coma

Question 6

What are the investigations in suspected Sepsis?

Answer 6

• ABG
• ECG
• CXR

Calculating the SOFA score, or the quickSOFA score if outside of ICU setting:

• RR > 22
• Altered mental state
• Systolic BP < 100mmHg

Score ≥ 2 shows higher risk of mortality

Question 7

What are the criteria for red or amber flags in Sepsis

Answer 7

RED FLAG CRITERIA:

• Responds only to voice or pain
• Acute confusional state
• Systolic BP < 90 mmHg
• HR > 130 bpm
• RR > 25
• Needs O2 to keep saturations above 92%
• Non blanching rash, mottled/ashen/cyanotic
• Not passed urine in 18 hours
• Urine output < 0.5 ml/kg/hr
• Lactate ≥ 2 mmol/L
• Recent chemotherapy

AMBER FLAG:

• Relatives concerned about mental state
• Acute detoriation in functional ability
• Immunosupressed
• Trauma/surgery in past 6 weeks
• RR 21-24
• Systolic BP 91-100 mmHg
• HR 91-130 bpm
• Not passed urine in last 12-18 hours
• Temperature < 36
• Clinical signs of wound, device or skin infection

High risk: 1 Red or 2 Amber

Moderate risk: 1 Amber

Low risk: No red or amber

Question 8

What is the management of sepsis?

Answer 8

SEPSIS 6

REMEMBER - Give 3 Take 3

1. Give O2, aim for > 94% saturation (88-92% COPD)
2. Take blood cultures
3. Give broad spectrum antibiotics
4. Give IV fluids - 500ml over 15 mins
5. Take serum lactate levels
6. Take urine output levels