Sepsis Flashcards
What is sepsis?
Life threatening organ dysfunction caused by an abnormal and uncontrolled host response to infection
What is the overall mortality of sepsis?
30-40%
What is the purpose of the criteria for sepsis?
Aids early identification of patients developing (or with) a clinical picture of sepsis
What criteria are required for a diagnosis of sepsis?
- Known or suspected infection
- Clinical features of organ dysfunction
What can be used to quantify the level of organ dysfunction?
SOFA score
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
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)
What is vital for any patient diagnosed with sepsis?
Immediate investigation and management
What is in the sepsis 6?
- Oxygen
- IV fluid therapy
- Blood cultures
- IV antibiotics
- Lactate
- Monitor urine output
What oxygen therapy should be given in sepsis?
Start 15L non-rebreathe and aim for target sats of 94-98%
What IV fluid therapy is given in sepsis?
500-1000ml fluid bolus, followed by ongoing fluid status re-assessment
When should blood cultures be taken in sepsis?
Before administering antibiotics
Other than blood, what cultures should be taken in sepsis?
Any other relevant cultures from suspected infection
What antibiotics should be given in sepsis?
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
What routine bloods should be done in sepsis?
- FBC
- U&Es
- LFTs
- Clotting
- CRP
- Glucose
How can lactate be quickly assessed?
Blood gas
How should urine output monitoring be done sepsis?
Catheterise if appropriate
What urine output is aimed for in sepsis?
> 0.5ml/kg/hour
What should nursing staff be told about patients with sepsis?
Take hourly jobs and inform you if any deterioration
What might further management of sepsis involve?
- Assessment by intensive care teams
- Vasopressor agents
- Renal replacement therapy
- Ventilator support
What is important in the investigation of sepsis cases?
Identification of infection source
What investigations may be appropriate in the investigation of sepsis cases?
- Urine dip +/- culture
- CXR
- Swabs, e.g. surgical wounds
- Operative site assessment
- CSF fluid sample (via LP)
- Stool culture
When should early involvement of intensive care/clinical outreach teams be considered?
- Evidence of septic shock
- Lactate >4.0mmol
- Failure to improve from initial management
What is septic shock?
Sepsis with hypotension, despite fluid resuscitation or requiring the use of inotropic agents to maintain a normal systolic BP
What does the management of septic shock usually involve?
Aggressive fluid resuscitation and antibiotic therapy, with likely involvement of the critical care team
What can be used to maintain organ perfusion in septic shock?
Inotropes
