Week 4 Flashcards
What is the Sepsis Trust Report?
- It is a document for people who want to help fix the way sepsis is dealt with by the NHS.
- The UK Sepsis Trust (UKST) exists to fight this life-threatening condition, stop preventable deaths and support those affected by sepsis.
What is included in the Sepsis Trust Report?
- Sepsis 6
- Red Flag Sepsis
- Professional Resources
- Sepsis E-Learning
- Educational Resources
Identify the 4 key stages listed in the Sepsis Screening Tool used in General Practice ( 12 + )
1 - Start charting if the patient looks unwell or has abnormal physiology
2 - Could this be due to an infection?
3 - Are there any red flags present?
4 - Are there any amber flags present?
Identify the risk factors listed in the FIRST stage of the Sepsis Screening Tool used in General Practice (12 +)
- Age 75 +
- Impaired Immunity ( Chemotherapy, Diabetes, Steroids etc )
- Recent Trauma / Surgery / Invasive Procedure
- Indwelling Lines / IVDU / Broken Skin
Identify the likely sources listed in the SECOND stage of the Sepsis Screening Tool used in General Practice (12 +)
- Respiratory
- Urine
- Skin / Joint / Wound
- Indwelling Device
- Brain
- Surgical
- Other
Identify the RED FLAGS listed in the THIRD stage of the Sepsis Screening Tool used in General Practice (12 +)
- Objective evidence of new or altered mental state
- Systolic BP ≤ 90 mmHg (or drop of >40 from normal)
- Heart rate ≥ 130 per minute
- Respiratory rate ≥ 25 per minute
- Needs O2 to keep SpO2 ≥ 92% (88% in COPD)
- Non-blanching rash / mottled / ashen / cyanotic
- Recent chemotherapy
- Not passed urine in 18 hours (<0.5ml/kg/hr if catheterised)
Identify the AMBER FLAGS listed in the FOURTH stage of the Sepsis Screening Tool used in General Practice (12 +)
- Relatives concerned about mental status
- Acute deterioration in functional ability
- Immunosuppressed
- Trauma / surgery / procedure in last 8 weeks
- Respiratory rate 21-24
- Systolic BP 91-100 mmHg
- Heart rate 91-130 or new dysrhythmia
- Temperature <36°C
- Clinical signs of wound infection
What is the course of action if there are RED FLAGS present in the Sepsis Assessment Tool ( 12 + )
RED FLAG SEPSIS = Start GP Bundle
What is the course of action if there are AMBER FLAGS present in the Sepsis Assessment Tool ( 12+ ) General Practice
- Use clinical judgement to determine whether the patient can be managed in community setting. If treating in the community, consider:
- -> Planned second assessment +/- bloods
- -> Specific safety netting advice
Talk me through the treatment guidelines for a patient who meets one or more of the HIGH RISK CRITERIA
Carry out a venous blood test for the following:
- Blood Gas ( Glucose & Lactate )
- Blood Culture
- Full Blood Count
- C-Reactive Protein
- Urea & Electrolytes
- Creatinine
- Clotting Screen
Administer antibiotics within the hour
Dependent on Lactate Level give intravenous fluid
- 4 mmol/L + or Systolic Blood Pressure <90 mmHg = 500ml/15 min within 1 hour
- 2 - 4 mmol/L = Intravenous fluid ( bolus injection ) within 1 hour
- <2mmol/L = consider intravenous fluid (bolus injection) within 1 hour
Carry out observations at least every 30 minutes or continuous monitoring
Talk me through the treatment guidelines for a patient who meets two or more of the MODERATE RISK CRITERIA or their systolic blood pressure is of 91 - 100mmHg
Carry out venous blood tests for the following:
- Blood Gas ( Glucose & Lactate )
- Blood Culture
- Full Blood Count
- C-Reactive Protein
- Urea & Electrolytes
- Creatinine
- Clotting Screen
Clinical review & results within 1 hour
Lactate 2mmol/L + or acute kidney injury = escalate to HIGH RISK
Lactate < 2mmol/L = if no definitive conditions identified, repeat structures assessment at least hourly, ensure review by a senior decision within 3 hours for antibiotic consideration
What is Sepsis 6?
The Sepsis Six is the name given to a bundle of medical therapies designed to reduce mortality in patients with sepsis.
Talk me through the process of assessing an individual for Sepsis, highlighted in Sepsis 6
Ask the person:
- Any recent fever or rigors.
- Any symptoms suggesting specific infection, such as dysuria or productive cough.
- Clinical features suggesting dehydration, such as reduced urine output in the past 18 hours.
- Any altered behaviour, mental state, or cognition
- Any sudden change or deterioration in functional ability.
- Possible risk factors for sepsis, including co-morbidities and drug treatments.
- Possible risk factors for antibiotic resistance, such as recent or previous antibiotic therapy, previous hospital admissions, and residency in a care home, for example.
- Immunization status (particularly in infants and young children).
Examine the person to assess for:
- General appearance, level of consciousness and cognition.
- Cognitive assessment
- Temperature.
- Fever is the most common presentation of sepsis.
- Heart rate, respiratory rate and signs of respiratory distress, and blood pressure.
- Signs of respiratory distress
- Blood Pressure
- Hypotension
- Capillary refill time and oxygen saturation
- Mottled or ashen skin; pallor or cyanosis of the skin, lips or tongue; cold peripheries.
- A non-blanching rash which may suggest meningococcal disease.
- Weak high-pitched or continuous cry (in children under 5 years of age).
- Any breach of skin integrity
- Dry mucous membranes or other signs of dehydration.
- The possible underlying source of infection.
List the high-risk risk factors for Sepsis
- Infants (under one year of age) and older people (over 75 years of age).
- People who are very frail.
- People who are immunocompromised due to a co-morbid condition
- People who are immunosuppressed due to drug treatment
- People who have had trauma, surgery, or other invasive procedures in the past six weeks.
- People with any breach of skin integrity
- People who misuse intravenous drugs or alcohol.
- People with indwelling lines or catheters.
- Women who are pregnant, are post-partum, or have had a termination of pregnancy or miscarriage in the past six weeks, including those who have:
Why is an intravenous fluid bolus given to an individual with suspected Sepsis?
- To help restore fluid bolus
What is the ‘normal’ range of Oxygen Saturation in COPD or CO2 retaining patients?
88 - 92%
