Sepsis

Question 1

Define colonisation?

Answer 1

the presence of a microbe in the human body without an inflammatory response

Question 2

Define infection?

Answer 2

inflammation due to a microbe

Question 3

Define bacteraemia?

Answer 3

the presence of viable bacteria in the blood

Question 4

Define sepsis?

Answer 4

the dysregulated host response to infection (overreaction by host to presence of infection)

Question 5

Define septic shock?

Answer 5

Septic shock is a subset of sepsis with circulatory and cellular/ metabolic dysfunctions associated with a high risk of mortality

Question 6

Criteria for septic shock?

Answer 6

Sepsis AND both of:
Persistent hypotension requiring vasopressors to maintain MAP greater than or equal to 65
Lactate greater than or equal to 2 mmol
(Despite adequate volume resuscitation)

Question 7

What scoring is used now?

Answer 7

NEWS 2

if score more than 5 and signs of infection - think sepsis

Question 8

What is the sepsis six bundle and when should it be delivered?

Answer 8

delivered within 1 hour

1. Oxygen
2. Fluid Challenge
3. Blood culture (and other relevant cultures)
4. Stat IV antibiotics
5. Lactate, FBC and biochemistry urgently
6. Monitor urine output

BUFALO (take 3, give 3)

Question 9

How many blood cultures do you need and should you take them before or after antibiotics?

Answer 9

One blood culture is enough (but 3 is better if it’s endocarditis)
Try to take cultures BEFORE antibiotics (except in purpura fulminans)

Question 10

Describe what should be done in the fluid challenge part of sepsis six?

Answer 10

Fluid challenge = set volume over set time
Prescribe 250-500mls over 15 minutes (crystalloid- 0.9% saline or Hartmanns)
Aim for MAP > 65 mmHg
Aim for 30 ml/kg over the first 3 hours
If lack of response in BP then consider early transfer to MHDU for CVC +/- vasopresors

Question 11

Explain why lactate is measured as part of sepsis six and what the protocol is?

Answer 11

Measure lactate (and other bloods)
High lactate, sign of hypoperfusion (low BP) in sepsis
High lactate associated with high mortality
If > 4 then this should be repeated at 4-6 hours

Question 12

Explain why urine output is measured as part of sepsis six and what the protocol is?

Answer 12

Marker of organ perfusion
Fluid balance should be commenced on admission
May require catheter insertion (gives better idea of fluid balance)