Sepsis

Question 1

Definition of sepsis…

Answer 1

Life threatening organ dysfunction due to dysregulated host response to infection
Usually causing a systemic inflammatory response syndrome.

Question 2

Signs to look out for in sepsis…

Answer 2

• Body temp >38 or <36
• Tachycardia (>100)
• Tachypnoea (>20)
• Hypotensive (SBP <100)
• Reduced urine output ( <0.5ml/kg/hr or anuria for >12h)
• Altered mental state

Question 3

qSOFA criteria in identifying sepsis…

Answer 3

In a patient with suspected sepsis, with presence of two or more of:

1. Hypotension - SBP<100mmHg
2. Altered mental status - GCS<15
3. Tachypnoea- RR> 22
   * Patients with score>2 are then required to have a full SOFA score to see if there is organ dysfunction

Question 4

Septic shock is defined as…

Answer 4

Sepsis alongside the following…

• Hypotension unresponsive to fluid resuscitation
• Lactate>2

Question 5

Risk factors for sepsis…

Answer 5

• Extremes of age
• Immunosuppression e.g chemotherapy, steroid use, splenectomy, pregnancy
• Chronic infection e.g. HIV
• Recent trauma -invasive procedure/ surgery in last 6 weeks
• Chronic illnesses e.g. cancer, diabetes, COPD, CF, CKD
• IVDU
• People with indwelling lines, drains, catheters

Question 6

Common causes of sepsis…

Answer 6

• Pneumonia
• Cellulitis
• Intra-abdominal infection e.g. perforation, post-op leaking anastomosis, biliary tract infection
• UTI , pyelonephritis
• Wound infection
• Septic arthritis
• Pelvic inflammatory disease
• Endocarditis
• CNS infections e.g. meningitis, cerebral abscess

Question 7

Potential complications of sepsis…

Answer 7

• Hypovolaemic shock
• ARDS
• AKI
• Hyperbilirubinaemia
• DIC
• Encephalopathy

Question 8

What is ARDS?

Answer 8

Acute respiratory distress syndrome:

• Causes fluid accumulation in the lungs, with a non-cardiogenic cause
• Sepsis causes inflammation which leads to endothelial cell dysfunction causing increased permeability of capillaries and reduced drainage of fluid from the lungs
• This leads to impaired oxygenation of the blood and alveolar collapse
• Hypoxia and SoB occur

Question 9

What are the vasopressors used in septic shock?

Answer 9

• 1st Line= Noraderenaline +/- vasopressin

* when 2nd line vasopressor is being used, swap noradrenaline with adrenaline

Question 10

Management of ARDS

Answer 10

Due to the severity of the condition it is usually managed in ITU:

• NIV with PEEP should be used initially
• Sedation and intubation –> if NIV is not meeting oxygen requirements

Question 11

What is neutropaenic sepsis?

Answer 11

Common complication that occurs due to myelotoxicity from chemotherapy - may present 7-14 days after chemotherapy.

Question 12

What is the clinical definition of neutropaenic sepsis?

Answer 12

- Neutrophil count <0.5x10^9 /L 
AND EITHER
- Temp >38C
OR
- Other signs/ symptoms consistent with sepsis

Question 13

What is the management of neutropaenic sepsis

Answer 13

• Empirical antibiotics should be given immediately- usually Tazocin
• Strict infection control: barrier nursing in a side room
• If still febrile and unwell after 48 hrs, switch to meropenem

Question 14

What can be given prophylactically to prevent neutropaenic sepsis?

Answer 14

If it is anticpated that a patient will have neutrophil count <0.5x10^9 from chemo - they should be given a fluoroquinolone