Sepsis

Question 1

What is sepsis?

Answer 1

Life threatening organ dysfunction caused by an abnormal and uncontrolled host response to infection

Question 2

What is the overall mortality of sepsis?

Answer 2

30-40%

Question 3

What is the purpose of the criteria for sepsis?

Answer 3

Aids early identification of patients developing (or with) a clinical picture of sepsis

Question 4

What criteria are required for a diagnosis of sepsis?

Answer 4

• Known or suspected infection

- Clinical features of organ dysfunction

Question 5

What can be used to quantify the level of organ dysfunction?

Answer 5

SOFA score

Question 6

just gunna copy and paste in the qSOFA stuff idk if its really that important cus never heard of it up to this point but whatever

Answer 6

The qSOFA score is a shortened version of the full SOFA criteria. It was developed to allow for the rapid assessment of potential sepsis, based purely on clinical signs.

The qSOFA score permits the diagnosis of potential sepsis to be made prior to any investigations and can be completed by any healthcare professional.

Any patient with a known or suspected infection and a qSOFA score ≥2 should be investigated and managed for sepsis as necessary. The qSOFA criteria are:

Respiratory Rate ≥ 22/min (1 point)
Altered Mental State (1 point)
Systolic Blood Pressure ≤100mmHg (1 point)

Question 7

What is vital for any patient diagnosed with sepsis?

Answer 7

Immediate investigation and management

Question 8

What is in the sepsis 6?

Answer 8

• Oxygen
• IV fluid therapy
• Blood cultures
• IV antibiotics
• Lactate
• Monitor urine output

Question 9

What oxygen therapy should be given in sepsis?

Answer 9

Start 15L non-rebreathe and aim for target sats of 94-98%

Question 10

What IV fluid therapy is given in sepsis?

Answer 10

500-1000ml fluid bolus, followed by ongoing fluid status re-assessment

Question 11

When should blood cultures be taken in sepsis?

Answer 11

Before administering antibiotics

Question 12

Other than blood, what cultures should be taken in sepsis?

Answer 12

Any other relevant cultures from suspected infection

Question 13

What antibiotics should be given in sepsis?

Answer 13

Start empirical antibiotics based on local guidelines, before switching to targeted therapy when sensitivities are available

can u edit this card for what they use in Leicester pls I can’t remember

Question 14

What routine bloods should be done in sepsis?

Answer 14

• FBC
• U&Es
• LFTs
• Clotting
• CRP
• Glucose

Question 15

How can lactate be quickly assessed?

Answer 15

Blood gas

Question 16

How should urine output monitoring be done sepsis?

Answer 16

Catheterise if appropriate

Question 17

What urine output is aimed for in sepsis?

Answer 17

> 0.5ml/kg/hour

Question 18

What should nursing staff be told about patients with sepsis?

Answer 18

Take hourly jobs and inform you if any deterioration

Question 19

What might further management of sepsis involve?

Answer 19

• Assessment by intensive care teams
• Vasopressor agents
• Renal replacement therapy
• Ventilator support

Question 20

What is important in the investigation of sepsis cases?

Answer 20

Identification of infection source

Question 21

What investigations may be appropriate in the investigation of sepsis cases?

Answer 21

• Urine dip +/- culture
• CXR
• Swabs, e.g. surgical wounds
• Operative site assessment
• CSF fluid sample (via LP)
• Stool culture

Question 22

When should early involvement of intensive care/clinical outreach teams be considered?

Answer 22

• Evidence of septic shock
• Lactate >4.0mmol
• Failure to improve from initial management

Question 23

What is septic shock?

Answer 23

Sepsis with hypotension, despite fluid resuscitation or requiring the use of inotropic agents to maintain a normal systolic BP

Question 24

What does the management of septic shock usually involve?

Answer 24

Aggressive fluid resuscitation and antibiotic therapy, with likely involvement of the critical care team

Question 25

What can be used to maintain organ perfusion in septic shock?

Answer 25

Inotropes