Sepsis

Question 1

What is sepsis?

Answer 1

Life-threatening organ dysfunction caused by dysregulated host response to infection

Question 2

What is septic shock?

Answer 2

A more severe form of sepsis that requires sepsis and vasopressor therapy to increase mean arterial pressure ≥65mmHg and lactate to >2mmol/L despite adequate fluid resuscitation

Question 3

Who is at risk of sepsis?

Answer 3

• Extremities of age
• Immunosuppression:
• Surgery/invasive procedure in last 6 weeks
• Breach of skin integrity
• IVDU
• Indwelling lines or catheters

Question 4

Who is immunosuppressed?

Answer 4

o Cancer (chemotherapy)
o Impaired immune function (diabetes, splenectomy, sickle cell)
o Long-term steroid use
o Immunosuppressant drugs

Question 5

Who is classed as a high risk sepsis patient?

Answer 5

Hx:
- New altered mental state

Respiratory:
- RR ≥ 25
Needs oxygen to keep SpO2 ≥ 92%

BP:
- Systolic ≤ 90mmHg

Circulation and hydration:

• HR >130
• Not passed urine in past 18hrs
• For catheterised patients, passed <0.5ml/kg/hour of urine

Skin:
- Mottled or ashen appearance
Cyanosis of skin, lips or tongue
Non-blanching rash

Question 6

Who is classed as a moderate-high risk sepsis patient?

Answer 6

Hx:

• Relatives concerned about behaviour or mental state
• Acute deterioration in functional ability
• Impaired immune system
• Trauma/surgery/procedure in last 6 weeks

Respiratory:
- RR 21-24

BP:
- Systolic 91-100mmHg

Circulation and hydration:

• HR 91-130
• New onset arrhythmia
• Not passed urine in past 12-18hrs
• For catheterised patients, passed 0.5-1ml/kg/hour of urine

Temperature:
- Tympanic temperature < 36

Skin:
- Redness, swelling, discharge at wound site

Question 7

What is sepsis 6?

Answer 7

Give 3, take 3

1. Administer oxygen
2. Give IV fluid challenges
3. Give broad-spectrum antibiotics
4. Take blood cultures
5. Measure serum lactate
6. Measure accurate hourly urine output

Question 8

What investigations would you do for sepsis?

Answer 8

• ABG
• Glucose
• Lactate
• FBC
• CRP
• U+Es
• Clotting screen
• LFTs

Question 9

What is the significance of lactate in sepsis?

Answer 9

Accumulates in the blood due to anaerobic respiration, showing poor tissue perfusion or shock and will result in organ damage and can lead to multi-organ failure

Lactate >4mmol/L
- High risk of circulatory collapse and cardiac arrest

Question 10

What is the significance of CRP in sepsis?

Answer 10

• Produced by the liver in response to inflammation

- Liver is normally affected first by the body maintaining oxygen to vital organs

Question 11

How do you manage sepsis?

Answer 11

• Give an IV broad-spectrum antibiotic at the maximum recommended dose
• Give an IV fluid bolus to restore tissue perfusion -> crystalloid 500ml bolus and reassess BP immediately after

Both within 1 hour of identifying that they meet high risk criteria