Sepsis

Question 1

Sepsis definition

Answer 1

Life threatening organ dysfunction due to dysregulated host response to infection

Question 2

How to identify septic shock?

Answer 2

• Vasopressor requirement to maintain SBP over 65

- Lactate greater than 2mmol/L in absence of hypovolaemia

Question 3

Pathophysiology of sepsis

Answer 3

Hallmark is deranged physiology
-Abnormal coagulation, endothelial cell dysfunction, presence of excessive TNF, cell apoptosis, neutrophil hyperactivity, poor glycaemic control, lack of steroid hormones, cytokines…

Question 4

Sepsis RF

Answer 4

Age, instrumentation or surgery, indwelling line or catheter, alcohol abuse, diabetes mellitus, breach of skin integrity, immunocompromise, medications, males, IV drug use, pregnancy

Question 5

Sepsis Presentation

Answer 5

Presenting features non-specific and vague

• Previous infection
• Then rapid deterioration despite antibiotics
• Non specific symptoms are common
• Enquire about infection source
• Ask about frequency of micturition in past 18 hours

Question 6

Sepsis Screening

Answer 6

NEWS

Question 7

Sepsis Ix

Answer 7

• FBCs
• Urine dipstick and sample for microscopy, culture and sensitivity
• Renal function
• LFTs
• Glucose
• Clotting screen (incl D dimer and fibrinogen)
• Cultures
• Radiology
• Measures of lactate and 02 sats
• ABG metabolic acidosis is common

Question 8

Sepsis Complications

Answer 8

DIC, adrenal failure, multi organ failure

Question 9

Sepsis Management

Answer 9

Sepsis six

• If high risk immediate review, if moderate risk, senior review within 3hrs if cause not identified
• alert senior if after 1hr SBP<90, RR>30, GCS reduced, raised lactate and not dropped by at least 20%

Question 10

Post Sepsis Syndrome?

Answer 10

Lethargy, muscle weakness, breathlessness, chest pain, oedema, arthralgia, poor appetite, anxiety depression, PTSD