SEPSIS

Question 1

WHAT IS SEPSIS?

Answer 1

exaggerated host response to infection leading to life threatening organ dysfunction and failure

Question 2

WHAT IS SEPTIC SHOCK?

Answer 2

sepsis with hypotension, despite adequate fluid resuscitation and use of inotropic agents

Question 3

HOW DO YOU IDENTIFY AND WHAT ARE THE RED FLAGS FOR SEPSIS?

Answer 3

1) Is there a clinical picture suggestive of an infection
2) Respiratory rate > 25/min or more
3) 02 SATS < 95%
4) Systolic BP < 91 mmHg or fall of 40 from normal
5) HR > 130/min
6) No urine output for 16 hours or UO < 10ml/hr
7) New onset delirium
8) Responds only to voice or pain/ unresponsive
9) Non- blanching rash/ mottled/ ashen/ cyanotic
10) Neutropenia or chemotherapy within last 6 weeks
(look online for the adult sepsis screening and immediate action protocol)

Question 4

HOW DO YOU MANAGE SEPSIS?

Answer 4

SEPSIS 6 BUNDLE

1) Administer supplementary oxygen - keep saturation >94% (unless COPD 88-92%), 15l high flow oxygen via non-rebreathable mask.
2) Blood cultures (before IV antibiotics) and source management - consider sputum, urine, CXR, CSF (via LP) to identify infection source
3) Give IV antibiotics - meropenem IV 1g STAT
4) IV fluid resuscitation - 500 ml of either Hartmann’s or 0.9% NaCl, followed by fluid status re-assessment.
5) Measure lactate - venous/ arterial blood gas, lactate > 4mmol refer to critical care
6) Measure urine output - aim for UO 0.5ml/kg/hr, catheterise if AKI

Question 5

AT WHAT LACTATE LEVEL SHOULD YOU REFER TO CRITICAL CARE?

Answer 5

> 4mmol/L

Question 6

HOW OFTEN SHOULD OBSERVATIONS BE TAKEN?

Answer 6

hourly

Question 7

WHAT OTHER INVESTIGATIONS SHOULD BE CARRIED OUT?

Answer 7

• FBC, CRP, U+E, LFTS, coagulation screen