Sepsis & Shock

Question 1

__?__ is defined as life-threatening organ dysfunction caused by dysregulated host response to an infection.

Answer 1

Sepsis

Question 2

What is the qSOfA score and how is it used?

Answer 2

qSOFA is the quick version of the SOFA score., which stands for Sequential (Sepsis-related) Organ Failure Assessment score.

The qSOFA focusses on three areas that may help identify patients at greater risk of mortality:

• Respiratory rate >22/min
• Altered mental state
• Systolic BP <100 mmHg

Question 3

What are the NICE recommended sepsis red flag symptoms?

Answer 3

If there is suspicion of infection and any of the following red flags are present, the ‘sepsis six’ should be started straight away:

AVPU: V, P or U

Acute confusional state

Systolic BP <=90, or drop >40 from normal

HR > 130 bpm

Resp. rate >= 25/min

New oxygen requirement

Non-blanching rash, mottled, ashen, cyanotic

Not passed urine in last 18 hours/ urine output <0.5 ml/kg/hr

Lactate >=2 mmol/L

Recent chemotherapy

Question 4

What are the ‘sepsis six’?

Answer 4

1. Blood cultures
2. Urine output, measure hourly accurately (catheter)
3. Fluid challenge (500ml crystalloid over less than 15 minutes)
4. Antibiotics, start broad spectrum while awaiting culture results
5. Lactate, measure serum
6. Oxygen: aim to keep sats >94% (or 88-92% if CO2 retention)

Question 5

What is the most common cause of early-onset neonatal sepsis in the UK?

Answer 5

Group B streptococcus infection

Question 6

What organisms cause post-splenectomy sepsis?

Answer 6

Streptococcus pneumonia
Haemophilus influenzae
Meningococci

Question 7

What antibiotic prophylaxis is offered to post-splenectomy patients?

Answer 7

Penicillin V 500mg BD

or

Amoxicillin 250mg BD