General - Sepsis

Question 1

1) What is septic shock?
2) How can this be measured (2)?

Answer 1

1) Arterial BP drop which results in organ hypoperfusion
2) Systolic BP < 90 despite fluid resuscitation
and hyperlactaemia (lactate > 4 mmol/L)

Question 2

Severe sepsis is defined when sepsis is present and results in organ dysfunction - name 3 symptoms of this

Answer 2

• Hypoxia
• Oliguria
• Acute Kidney Injury
• Thrombocytopenia
• Coagulation dysfunction
• Hypotension
• Hyperlactatemia (> 2 mmol/L)

Question 3

Name 2 patients with a higher risk of developing sepsis

Answer 3

• Very young or old patients (>1 or <75 years)
• Chronic conditions such as COPD and diabetes
• Chemotherapy, immunosuppressants or steroids
• Surgery or recent trauma or burns
• Pregnancy or peripartum
• Indwelling medical devices such as catheters or central lines

Question 4

What score is used to pick up the signs of sepsis, and what 7 features is this score based on?

Answer 4

National Early Warning Score (NEWS):
- Temperature
- Heart rate
- Respiratory rate
- Oxygen saturations
- Blood pressure
- Consciousness level

Question 5

Name 2 signs on examination that may indicate sepsis

Answer 5

• Signs of potential sources i.e. cellulitis, discharge from wound, cough or dysuria
• Non-blanching rash (meningococcal septicaemia)
• Reduced urine output
• Mottled skin
• Cyanosis
• Arrhythmias such as new onset atrial fibrillation

Question 6

1) What is often the 1st sign of sepsis?
2) How do elderly patients often present initially?

Answer 6

1) High RR - tachypnoea
2) Confusion or drowsiness

Question 7

Sepsis is treated promptly with the sepsis six which involves 3 investigations and 3 treatments - what are they?

Answer 7

Investigations
- Blood lactate level
- Blood cultures
- Urine output
Treatments
- Oxygen to maintain sats 94-98% (88-92% in COPD)
- Empirical broad spectrum antibiotics
- IV fluids

Question 8

1) What is neutropenic sepsis?
2) What is neutropenia commonly caused by?
3) Neutropenic sepsis is typically treated with broad spectrum antibiotics - name one of these

Answer 8

1) Sepsis in a patient with a low neutrophil count of less than 1 x 109/L
2) Anti-cancer or immunosuppressant treatment
3) Piperacillin with tazobactam (tazocin)

Question 9

How does IL1 result in sepsis?

Answer 9

Vasodilator - hypotension