Sepsis

Question 1

Define Sepsis

Answer 1

Serious and life-threatening systemic infection (RCOG)

Question 2

MBRRACE

Answer 2

Sepsis is the cause of 3% of maternal deaths

Question 3

Incidence rate

Answer 3

0.1-0.3%, risk doubles in pregnancy and labour

Question 4

Risk factors of sepsis

Answer 4

• Substance misuse raised BMI, BAME, Smoking, Anaemia, Diabetes
• Intrapartum–> Retained products, C-section, UTI, Mastitis, Chorioamniotitis, perineal and vaginal trauma, ARM, PROM, Catheters.

Question 5

Stages of Sepsis

Answer 5

Localised infection triggers systemic response. SIRS.
SIRS has several mechanisms, pyrexia, vasodilation (low BP), Low or High WBC, Temp >38 or <36. Tachycardia, Tachypnoea.
Leads to septic shock - Hypotension, Reduced perfusion, hypoxia.

Question 6

Symptoms

Answer 6

Tachycardia, Tachypnoea, Oligouria, Rash, Abdo pain, Offensive smelling vaginal discharge.

Question 7

Why do we need quick venous access?

Answer 7

In Septic Shock, hypotension occurs which can lead to peripheral veins collapsing.

Question 8

What are the sepsis 6?

Answer 8

Give Oxygen- 15 L/min
Give Antibiotics
Give Fluid Balance 
Take Bloods
Take Blood Cultures
Catheterise with urometer using ANTT

Question 9

What cannulas?

Answer 9

2x 16G cannulas. Cannula care to prevent phlebitis

Question 10

What bloods for sepsis?

Answer 10

FBC- Hb, PLT (DIC can occur in septic shock), WBC
Clotting bloods for ?DIC
Us&Es- for kidney function, raised creatinine (poor kidney function)
LFTs- Liver function, Raised ALTs indicate liver damage
CRP- quick-acting infection marker
Lactate- due to poor perfusion in sepsis, lactate will increase
Capillary glucose- Hyperglycaemia with sepsis.
Venous blood gas- to indicate metabolic dysfunction

Question 11

Lactate management?

Answer 11

Lactate> 1mmol obstetric r/v with fluid protocol of 30ml/kg
>2mmol urgent obstetric r/v with fluid protocol of 30ml/kg
> 4mmol urgent consultant r/v with fluid protocol of 30 ml/kg, liaise with critical care team.

Question 12

Fluids?

Answer 12

1l hartmanns preferrably warmed to increase circulation volume due to hypotension and fluids leaking from vessels to improve perfusion

Question 13

Antibiotics?

Answer 13

Broad spectrum antibiotics e.g. cef (1.5g) and met (500mg). CHECK ALLERGIES & DRUG CONTRAINDICATIONS

Question 14

Pyrexic?

Answer 14

1g paracetamol IV

Question 15

Review?

Answer 15

Full review from obstetric team. Infection screen, high and low vaginal swab, nasal & throat swab, sputum sample, CSU/MSU, Wound swab, Breastmilk sample.

Question 16

After care

Answer 16

Repeat bloods at 6&12 hours r/v with reg/ consultant
Continue IV antibiotics for 3 days
Move to oral for a further 5 days
1:1 care on CDS. ?ITU/HDU
Normal PN care, BFS, TWOC, Pain care. 
VTE score 
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