Sepsis (cellulitis, abscess, intra-abdominal)

Question 1

Definition of sepsis

Answer 1

life-threatening organ dysfunction caused by an abnormal and uncontrolled host response to an infection.

Question 2

What is the qSOFA score?

Answer 2

Respiratory Rate ≥ 22/min (1 point)
Altered Mental State (1 point)
Systolic Blood Pressure ≤100mmHg (1 point)

a qSOFA score ≥2 should be investigated and managed for sepsis as necessary

Question 3

Management

Answer 3

1 Oxygen Start 15L O2 via a non-rebreathable mask, aiming for target saturations 94-98% (or 88-92% in chronic retainers), only titrating once appropriately saturating
2 IV fluid therapy 500-1000mL initial fluid bolus, followed by ongoing fluid status re-assessment
3 Blood cultures Take blood cultures prior to administering antibiotics, along with any other relevant cultures from the suspected infection site
4 IV antibiotics Start empirical antibiotics (based on local guidelines), before switching to targeted therapy when sensitivities are available
5 Routine bloods, inc. lactate Routine bloods should include FBC, U&E, LFTs, clotting, CRP, and glucose; lactate can be quickly be assessed rapidly from a blood gas
6 Monitor urine output Catheterise the patient if appropriate and accurately monitor urine output; aim for at least >0.5mL/kg/hour

Question 4

Further management

Answer 4

assessment by intensive care teams and commencing vasopressor agents (e.g. noradrenaline), renal replacement therapy, and/or ventilator support.

Question 5

Identifying source

Answer 5

Urine dip +/- culture
Chest X-ray (CXR)
Swabs (e.g. surgical wounds)
Operative site assessment (via CT or US imaging)
Cerebrospinal fluid sample (via LP)
Stool culture

Question 6

When to escalate management

Answer 6

Evidence of septic shock
Lactate > 4.0mmol
Failure to improve from initial management

Question 7

Common sources (surgical)

Answer 7

Chest (infection)
Cut (wound infection)
Catheter (UTI)
Collections (abdomen, pelvic etc.)
Calves (DVT)
Cannula (infection, if applicable)
Central line (infection, if applicable)

Question 8

Septic shock definition

Answer 8

sepsis with hypotension, despite adequate fluid resuscitation

Question 9

Managing septic shock

Answer 9

usually involves aggressive fluid resuscitation and antibiotic therapy, with the likely involvement of the critical care team. Inotropes are often used to maintain organ perfusion.