Sepsis Management

Question 1

Risk Factors for sepsis

Answer 1

Extremes of age 
Recent surgery / trauma <6 weeks
Impaired immunity 
Indwelling catheters / lines
IVDU
Breaks in skin integrity

Question 2

What indicates the severity of sepsis

Answer 2

Lactate
<2 mmol/L = mild
2-4 mmol/L = moderate
>4 mmol/L = severe

Question 3

What parameters suggest a risk of severe illness or death from sepsis

Answer 3

Mental status

• High risk - objective altered mental status
• Mod risk - hx of altered mental state

Resp rate

• High risk - >25 or new O2 requirement
• > 20

Heart rate

• High risk - >130
• > 100

SPB

• <90 or >40 below normal
• <100

UO

• <0.5ml/kg/hour (or no urine in >18 hours)
• <1ml/kg/hour (or no urine in >12 hours)

Others
High risk - cyanosis/mottled, non-blanching rash
Mod risk - recent surgery/trauma, temp <36, signs of infection

Question 4

What end organ dysfunction can occur due to sepsis

Answer 4

Respiratory - acute respiratory distress syndrome

• impaired oxygenation, high RR, infiltrates on CXR
• Mx = mechanical ventilation

CV - myocardial dysfunction/failure, hypovolaemia, septic shock

• persistent hypotension
• Mx = inotropes / vasopressors

Kidneys - AKI

• UO <0.5 / Cr >50% baseline
• RRT if required

Liver - liver dysfunction
- Bilirubin >35 and ALP/ALT >2x normal

Coagulation - coagulopathy / DIC

• Thrombocytopenia, Prolonged PT, Low fibrinogen, high D-dimer
• Mx = blood products (red cells, platelets, FFP, cryoprecipitate)

Neuro - encephalopathy
- new confusion / low GCS

Question 5

Management of sepsis

Answer 5

Sepsis 6 - within 1 hour

Give:

• IV fluids
• IV Abx (target source if clear, broad spec if not)
• Oxygen

Take:

• UO
• Blood cultures
• Lactate and Hb