Sepsis

Question 1

What is sepsis vs septic shock

Answer 1

• Sepsis - lifethreatening organ dysfunction caused by dysregulated host response to infection
• Septic shock - subset of sepsis with profound circulatory, cellular and mentabolic abnormalities, associated with greater risk of mortality than sepsis alone

Question 2

Adults sepsis screening and immediate action tool

Answer 2

1. At least one of the following - EWS 3 or more, or pt looks unwell or concern re acute mental status change
2. Clinical picture suggesting infection?
3. One red flag -
   RR 25 or more
   New need for more than 40%O2,
   Systolic BP less than 91 or fall of 40mmHg from normal
   HR more than 130
   No urine output fot 16hrs or less than 10ml/hr
   New onset delirium
   Responds only to pain/voice/unresponsive
   Non-blanching/mottled/ashen/cyanotic
   Neutropenia or chemo within last 6 weeks

Question 3

Sepsis 6 bundle

Answer 3

Complete within 1hr
* Oxygen (if needed ofc, aim sats above 94% in COPD 88-92%)
* Blood cultures (before IV abx)
* Fluid challenge (if systolic less than 90 or lactate more than 2)
* Measure lactate - VBG/ABG
* Measure urine output
* Escalate

Question 4

Initial IV abx for sepsis if unsure of source

Answer 4

Meropenem

Question 5

10 point appraoch to patient with infection

Answer 5

1. Evidence for infection
2. Severity?
3. Patient factors
4. Body system/organ affected?
5. Micro-organisms involved?
6. Which abx needed?
7. Route of administation
8. Any other treatment?
9. Rsik transmission to others?
10. Planning for f/u and discharge

Question 6

Abx for sepsis of skin origin

Answer 6

Benzylpenicillin / Flucloxicillin

Question 7

Abx for MSK sepsis source

Answer 7

Same as skin