Sepsis

Question 1

Which A-E is this problem about?

Answer 1

ela de
B/C

Question 2

Airway

Answer 2

patent

Question 3

Breathing

Answer 3

Look: increase respiratory effort, WOB

Listen: chest, ? bronchial breathing, ? crackles, cough

Feel: chest expansion, tracheal deviation

• RR – increased
• O2 – might be decreased

ABG – look for lactate and start applying qSOFA score
* RR > 22
* BP < 100
* GCS < 15

Chest xray – to rule out consolidation

Question 4

Circulation

Answer 4

Look: mottled skin appearance

Listen: heart

Feel: pulse, cold peripheries, slow CRT

Obs
- HR – tachy
- BP – hypotensive
- ECG

Bloods: FBC, UEs, LFTs, CRP, ESR, blood cultures

Put cannulas in

Management: START WITH ‘ I WOULD BE WORRIED ABOUT SEPSIS LOOKING OUT HIGH RISK CRITERIA AND APPLYING THE SEPSIS 6’

1) Apply SOFA score

(respiratory rate (RR) ≥ 22 breaths per minute, altered mentation (Glasgow Coma Scale [GCS] < 15), and systolic blood pressure (SBP) < 100 mmHg)

GCS < 15
RR> 22
SBP < 100

2) Initiate sepsis 6 protocol according to local guidelines

3) Start broad sprectrum ABx - Tazosin 4.5 IV QDS, + vancomycin if MRSA / severe HAI

4) Give fluid bolus 500 ml - 1000 ml NaCl over 15 minutes

5) Give oxygen 15L via NRB mask

6) Catheterize patient

7) ABG done already

Escalation
* Immediate senior review ST3 or above
* Speak to ICU
* Inotropes, ventilation, haemofiltration

Question 5

Disability

Answer 5

1) Glucose

2) PEARL

3) GCS

Question 6

Exposure

Answer 6

Skin rashes

Abdominal exam to rule out abdo source – peritonitis

Urinary retention to rule out urosepsis

Urine dip to rule out urosepsis + send urine culture

Calves

Temperature

Urine output

SURGICAL – LINES AND DRAINS AND PICC LINES!!!!!

Question 7

Management of sepsis

Answer 7

Question 8

High risk criteria in sepsis

Answer 8

1. Confusion
2. hypoxia
3. HR >130
4. RR >25
5. Hypotension SBP <90
6. Poor urine output
7. Non-blanching rash
8. Lactate >2
9. Pt receiving chemotherapy

Sepsis: life treathening organ dysfunciton due to dyregulated host response to infection

Septic shock: sepsis + despite adequate fluid resuscitation, hypotention requiring inotropes to maintain MAPs >65, or lactate 2

Question 9

Neutropenic sespsis

Answer 9

• Suspect if previous chemo in 30 days, MDS
• Do stat WCC, although dont wait to treat - absolute neutrophil count of 0.5 x 109/L or lower
• DO sepsis 6
• Tazosin 4.5 g IV QDS (if severe: vancomycin + gentamicin + metronidazole)
• Escalate to onc reg, haem reg, and immediate senior review