Severe Sepsis

Question 1

Clinincal Severity Prompts (10)

Answer 1

Immunocompromised patients

Indwelling medical device

Recent surgery / invasive procedure

Hx of fevers or rigors

Red flags in Ambulance handover

Skin: cellulitis, wound

Urine: dysuria, frequency, odour

Abdomen: pain, peritonism

Chest: cough, shortness of breath

Neuro: deccreased mental alertness, neck stiffnes, headache

Question 2

History Prompts

Answer 2

Onset

Recent overseas travel

Relevant past history: diabetic, age

Medication history

Allergies

Question 3

Immediately ⇒

Answer 3

… call for assistance and notify the Medical Officer and Medical Retrieval Service.

Question 4

Airway - Assessment

Answer 4

Assess patency

Question 5

Airway - Intervention

Answer 5

Maintain airway patency

Question 6

Breathing - Assessment

Answer 6

Respiratory rate and effort.

SpO2

(Auscultation)

Question 7

Breathing - Intervention

Answer 7

Assist ventilaiton if required

Apply O2 to maintain SpO2 > 95%

Question 8

Circulation - Assessment

Answer 8

Skin temp (touch)

Pulse - rate / rhythm

Capillary refill

Blood pressure

Cardiac monitor

Electrocardiography

Question 9

Circulation - Intervention

Answer 9

IV cannulation / pathology

If SBP < 90mmHg give IV/IO 0.9% NaCl 500ml bolus

Monitor vital signs frequently

12-lead ECG

Question 10

DO NOT DELAY …

Answer 10

ANTIBIOTIC ADMINISTRATION.

Question 11

Disability

Answer 11

AVPU/GCS + pupils ⇒ monitor LOC frequently

Finger prick BGL ⇒ if BGL < 3.0mmol/L and conscious administer simple sugar

or

If unconscious or confused, administer IV 50% Glucose 50ml

or

If IV access unavailable, administer IM Glucagon 1ml

Finger prick BGL every 15 minutes until within normal limits and the patient mentally alert

Question 12

Measure and test

Answer 12

Pathology ⇒ bloods for FBC, UEC, LFT, coags, blood cultures x 2, venous blood gas.

Temperature ⇒ If < 35.5^oC apply warming adjunct. If > 38.5^oC give oral Paracetamol 500mg - 1g

U/A ⇒ Full urinalysis + urine culture

Fluid input/output ⇒ FBC and insert IDC (hourly output)

Chest x-ray (if available)

Question 13

Specific treatment

Answer 13

Fluid/hydration ⇒ IV 0.9% NaCl 1000ml (125ml/hr)

Antibiotics ⇒ IV/IO Flucloxacillin 2g

and

IV Gentamicin 7mg/kg for the first dose (max 640mg)

**If allergic to Penicillin, give IV Vancomycin (according to pt’s body weight)