New definition of Sepsis
Life-threatening organ dysfunction caused by a dysregulated host response to infection
New definition of Septic Shock
Sepsis with persisting hypotension requiring vasopressors such as Noradrenaline or Vasopressin to maintain a mean arterial pressure (MAP) ≥65mmHg and having a serum lactate level >2mmol/I despite adequate fluid resuscitation
Who was William + what went wrong?
Baby William died of blood poisoning following a chest infection
- Poor GP records and advice to parents
- Symptoms were not seen as serious
- Out-of-hours GP service did not have access to primary care records
- NHS 111 advisers ‘pathway’ tool was too vague to pick up red flag symptoms for Sepsis
Who’s at Risk of Sepsis?
- Infants less than 1 year
- Elderly more than 75 years
- Impaired immune responses
+ From chemotherapy, long term steroid use, impaired immune function, taking immunosuppressants - Anyone with a breach of skin integrity (damaged skin, scratch, sore)
- Intravenous drug users
- Pregnant women
- indwelling line (needle/catheters)
Those having trauma, surgery or invasive procedures in past 6 weeks
Why have so many people died?
- Health service ombudsman - NHS only treating 1 in 4 patients correctly
- Poor recognition of symptoms by HCP
- Symptoms can be subtle
- Not all patients with Sepsis are in the ITU (Intensive care unit)
How do you manage Sepsis?
Septic Six
Outline Septic Six
(1) Administer Oxygen SpO2 > 94%
(2) Take blood cultures + consider infective source
(3) Give intravenous antibiotics
(4) Start intravenous fluid resuscitation
(5) Check serial lactates + send required blood test
(6) Measure urine hourly
Other ways in managing Sepsis
Dictated by patient’s condition however
- Rationalise (reduce) antimicrobial therapy Includes Vasopressors (increase blood pressure), Inotropes ( increase myocardial contractility-heart muscle in generating force), Glucocorticoid therapy
How can we improve survival rates?
NEWS - national early warning system
Early recognition of sepsis in primary + secondary care
Early intervention improves outcomes - saves 12 500 lives a year
What are the 6 physiological parameters used in NEWS?
TOPLRS Temperature Oxygen saturations Pulse rate Level of Consciousness Respiratory rate Systolic blood pressure
How many people die of sepsis in the UK?
44 000
How much does sepsis cost to the UK?
2 billion
What is NEWS?
Score is allocated to physiological measurement undertaken when patients are present or monitored in hospital
