11: Summary of sepsis

Question 1

What is the first question you must answer before diagnosing sepsis?

Answer 1

Infection or not?

Question 2

After deciding there is infection, what question should you ask?

Answer 2

Where is the infection that is causing sepsis

i.e which antibiotic man antibiotics do I choose

Question 3

After you’ve confirmed the site of infection, a NEWS score of > __ says their response is excessive.

What are the corresponding qSOFA and SIRS scores?

Answer 3

NEWS > 5

qSOFA > 2

SIRS > 2

Question 4

Which response must you give within 1 hour if you reckon a patient’s response to infection is excessive?

Answer 4

SEPSIS SIX

BUFALO

Question 5

What are some special considerations when administering sepsis six?

Answer 5

COPD

Endocarditis (3 samples instead of 1)

Heart failure (be careful with fluids)

C. diff (oral vanc!)

loads of others

Question 6

What are the steps in diagnosing infection?

Answer 6

HISTORY

EXAMINATION

INVESTIGATIONS - radiologym biochemistry, immunology, microbiology sampleS, PCR, molecular studies

Question 7

What sorts of patients may have abnormal responses to infection?

cards for abnormal pathogens and abnormal sites

Answer 7

Younger/older

Pregnant

Immunosuppressed

Co-morbidities

Question 8

What patient must be treated very differently from an acute care adult in terms of sepsis?

Answer 8

People presenting to GPs (e.g rural patients)

Pregnant women

Children

Question 9

If a patient’s NEWS is 5 or more, think ___.

Answer 9

sepsis

Question 10

What must you remember to do when taking blood for culture?

Answer 10

Take samples from all other relevant sites

Question 11

How many cultures need to be taken in Sepsis 6?

Answer 11

One

(Three for endocarditis)

Question 12

What must you do with pus?

Answer 12

Drain it

Question 13

How are viruses e.g flu identified?

Answer 13

Viral PCR

Question 14

What are the 4 Ds of antimicrobial therapy?

Answer 14

Dose

Duration

Dform

De-escalate

Question 15

Which antibiotics can cause C. diff infection?

Answer 15

All of them

but the 4Cs in particular

Question 16

Which fluoroquinolones can cause C. diff infection?

Answer 16

All of them

but ciprofloxacin has a c in it

Question 17

Which capsular antigen is associated with H. influenzae?

Answer 17

Type B

hence it’s called the HiB vaccine

Question 18

antigens may be asked about - learn some

Question 19

get your hands on a colonisers diagram

e.g “an oral swab found candida” is not suspicious