What is sepsis?
Life-threatening organ dysfunction caused by dysregulated host response to infection
What is septic shock?
A more severe form of sepsis that requires sepsis and vasopressor therapy to increase mean arterial pressure ≥65mmHg and lactate to >2mmol/L despite adequate fluid resuscitation
Who is at risk of sepsis?
- Extremities of age
- Immunosuppression:
- Surgery/invasive procedure in last 6 weeks
- Breach of skin integrity
- IVDU
- Indwelling lines or catheters
Who is immunosuppressed?
o Cancer (chemotherapy)
o Impaired immune function (diabetes, splenectomy, sickle cell)
o Long-term steroid use
o Immunosuppressant drugs
Who is classed as a high risk sepsis patient?
Hx:
- New altered mental state
Respiratory:
- RR ≥ 25
Needs oxygen to keep SpO2 ≥ 92%
BP:
- Systolic ≤ 90mmHg
Circulation and hydration:
- HR >130
- Not passed urine in past 18hrs
- For catheterised patients, passed <0.5ml/kg/hour of urine
Skin:
- Mottled or ashen appearance
Cyanosis of skin, lips or tongue
Non-blanching rash
Who is classed as a moderate-high risk sepsis patient?
Hx:
- Relatives concerned about behaviour or mental state
- Acute deterioration in functional ability
- Impaired immune system
- Trauma/surgery/procedure in last 6 weeks
Respiratory:
- RR 21-24
BP:
- Systolic 91-100mmHg
Circulation and hydration:
- HR 91-130
- New onset arrhythmia
- Not passed urine in past 12-18hrs
- For catheterised patients, passed 0.5-1ml/kg/hour of urine
Temperature:
- Tympanic temperature < 36
Skin:
- Redness, swelling, discharge at wound site
What is sepsis 6?
Give 3, take 3
- Administer oxygen
- Give IV fluid challenges
- Give broad-spectrum antibiotics
- Take blood cultures
- Measure serum lactate
- Measure accurate hourly urine output
What investigations would you do for sepsis?
- ABG
- Glucose
- Lactate
- FBC
- CRP
- U+Es
- Clotting screen
- LFTs
What is the significance of lactate in sepsis?
Accumulates in the blood due to anaerobic respiration, showing poor tissue perfusion or shock and will result in organ damage and can lead to multi-organ failure
Lactate >4mmol/L
- High risk of circulatory collapse and cardiac arrest
What is the significance of CRP in sepsis?
- Produced by the liver in response to inflammation
- Liver is normally affected first by the body maintaining oxygen to vital organs
How do you manage sepsis?
- Give an IV broad-spectrum antibiotic at the maximum recommended dose
- Give an IV fluid bolus to restore tissue perfusion -> crystalloid 500ml bolus and reassess BP immediately after
Both within 1 hour of identifying that they meet high risk criteria
