What is sepsis?
A life-threatening organ dysfunction caused by a dysregulated host response to infection.
Give some patient groups who are more at risk of sepsis
- Children <1
- Adults >75
- Frail
- Immunocompromised
- Post-surgery
- Damage to skin e.g. burns, blisters, wounds
- IV drug users
- Lines or catheters
Give some symptoms of sepsis
- Localising symptoms of infection e.g. productive cough, vomiting, diarrhoea, dysuria
- Confusion
- Drowsiness
- Clammy/sweaty
- Malaise
- SOB
Give some signs of sepsis
- Tachycardia
- Tachypnoea
- Hypotension
- Fever or hypothermia
- Cyanosis
- Low O2 sats
- Delayed CRT
- Oliguria
- Dry mucous membranes
- Non-blanching rash
- Mottled/ashen appearance
How is the CRT affected by sepsis?
Prolonged
How is urine output affected by sepsis?
Oliguria
Define oliguria
Reduced urine output (oliguria) is typically defined as <0.5ml/kg/hour in an adult
What RED FLAGS can be seen in sepsis in ‘breathing’
- Tachypnoea → RR >/= 25
- Low O2 sats → oxygen required to keep SpO2 >/= 92%
What RED FLAGS can be seen in sepsis in ‘circulation’?
- Hypotension → systolic BP = 90 mmHg
- Tachycardia → HR >130 bpm
- Prolonged CRT
What lactate level is a red flag for sepsis?
Lactate >/= 2 mmol/l
What RED FLAGS can be seen in sepsis in ‘disability’?
- Responds only to voice or pain, or unresponsive (ACVPU)
- Acute confusional state
What RED FLAGS can be seen in sepsis in ‘exposure’?
- Non-blanching rash
- Mottled, ashen appearance or cyanotic
- Urine output <0.5 ml/kg/hour
What urine output is a red flag for sepsis?
Urine output <0.5 ml/kg/hour
If sepsis is suspected, what are your management steps?
Blood cultures
Urine output
Fluids IV
Antibiotics IV
Lactate
Oxygen
What should always be checked before administering antibiotics?
allergies → red penicillin band?
What RR is a red flag for sepsis?
>/= 25 (tachypnoea in general suggests sepsis)
What SpO2 suggest sepsis?
Hypoxaemia (<94%)
What symptoms may indicate the chest as the source of sepsis?
a productive cough with purulent sputum
What auscultation findings may indicate the chest as the source of sepsis?
bronchial breath sounds and/or coarse crackles indicate consolidation (pneumonia → sepsis)
What percussion findings may indicate the chest as the source of sepsis?
Dull
What intervention should be done in ‘breathing’ in patients with suspected sepsis? Why?
Sit up & 15L/min oxygen via non-rebreathe mask
To try correct hypoxaemia
What investigations should be ordered in ‘breathing’ in suspected sepsis?
ABG
Portable CXR
Sputum culture (if appropriate)
How is BP affected in sepsis?
Hypotension
Systolic BP = 90 mmHg or a drop of >40 mmHg from the patient’s normal blood pressure is considered red flags for sepsis
How is pulse affected in sepsis?
- Tachycardia is a common feature of sepsis
- HR >130 bpm is a red flag for sepsis
