SEPSIS

Question 1

What is the technical definition of sepsis?

Answer 1

Life threatening organ dysfunction due to a dysregulated host response to infection

Question 2

What is septic shock? (think key numbers)

Answer 2

Septic shock has also been redefined as a subset of sepsis in which there is co-existence of: persistent hypotension requiring vasopressors to maintain mean arterial pressure ≥65 mmHg; and serum lactate >2 mmol/L (>18 mg/dL).

Question 3

What is the qSOFA score? What score is considered significant?

Answer 3

• The qSOFA score is an alternative to early warning scores for detecting signs of early organ dysfunction in a patient with a presumed infection (i.e., sepsis).
• The qSOFA score is a simple clinical evaluation recommended by the Third International Consensus Group (Sepsis-3) for bedside use to detect the risk of deterioration due to sepsis.Using qSOFA, a patient is considered to be at high risk of an adverse outcome if at least two of the following three criteria are present:
  
  • Altered mental state (Glasgow Coma Scale [GCS] <15)
  • Systolic BP ≤100 mmHg
  • Respiratory rate ≥22 breaths/minute.

Question 4

What is the sofa score?

Answer 4

The SOFA score is primarily used in research, and when used in clinical practice it is more commonly confined to an ICU setting. The SOFA score is calculated based on the evaluation of multiple systems (with a score of ≥2 in a patient with a suspected infection being suggestive of sepsis)

Question 6

What are the SIRS criteria?

Answer 6

SIRS is defined by the presence of any two or more of the following clinical signs and laboratory investigation findings:[2][73]

• Temperature >38.3°C or <36.0°C
• Tachycardia >90 bpm
• Tachypnea >20 breaths/minute or PaCO₂ <32 mmHg
• Leukocytosis (WBC count >12,000/microliter) Leukopenia (WBC count <4000/microliter)
• Normal WBC count with >10% immature forms
• Hyperglycemia (blood glucose >140 mg/dL [>7.7 mmol/L]) in the absence of diabetes mellitus
• Acutely altered mental status.

Question 7

What are the sepsis 6?

Answer 7

1. High flow O2
2. 500ml fluid over 15 minutes
3. Blood cultures
4. IV broad spec ABx
5. Catheterise
6. ABG for lactate

Question 8

What goes into a sepsis screen?

Answer 8

1. Urine dip +/- culture
2. Chest X-ray (CXR)
3. Swabs (e.g. surgical wounds)
4. Operative site assessment (via CT or US imaging)
5. Cerebrospinal fluid sample (via LP)
6. Stool culture

Question 9

What are the indications that a septic patient may need to be managed in ITU?

Answer 9

• Evidence of septic shock
• Lactate > 4.0mmol
• Failure to improve from initial management
• Potential requirement for intubation