Sepsis in Hospital

Question 1

What is Red flag sepsis

Answer 1

NEWS2 - 7+
NEWS2 - 5-6 AND
-lactate 2+ or
-chemo in last 6wks
-evident organ failure
-patient looks extremely unwell or active deterioration

Question 2

How quickly should the Sepsis 6 be delivered

Answer 2

Treat within 1hr of recognition
-Bloods - GLU, LAC, FBC, U&E, CRP, clotting, cultures
-ABx - loading dose within 1hr of diagnosis
-Fluids - 500ml bolus in U15mins (0.9% saline/Hartmans
-Measure UOP with catheter
-Repeat lactate at least once per hour if initial lactate high/clinical condition changes

Senior review within 1hr

Plan for escalation and source control within 3hrs

Question 3

ABx route
-when to review

Answer 3

IV ABx
Review prescription and switch to oral once stable

Question 4

Renal function
-how would you manage sepsis with this background

Answer 4

First loading dose of Abx, regardless of renal function
Adjust subsequent doses according to renal function

Question 5

Clinical risk stratification

Answer 5

Low - 0-4
Low to medium - 3 in any individual paramter

Medium - 5-6
-must assess for risk of sepsis

High - 7+

Question 6

What is Amber flag sepsis
How would you manage it?

Answer 6

NEWS2 - 5-6
NEWS2 - 1-4 AND
-lactate 2+
-chemo in last 6 wks
-evident organ failure
-patient looks extremely unwell or actively deteriorating

Send and review bloods - FBC, U&E, CRP, clotting
Escalate to senior within 1hr
Consider if ABx needed, make a plan for source control and escalation within 3hrs

Question 7

What is septic shock

Answer 7

Type of sepsis where profound circulatory, cellular, metabolic abnormalities increase mortality

Persisting hypotension needing vasopressors to maintain MAP 65+ and having 2+ lactate despite adequate volume resus

Question 8

What can mask sepsis

Answer 8

Bb - mask tachycardia
Paracetamol - mask fever

Cryptic shock - lactate 2+ and normal BP

Sepsis induced hypotension with no elevated lactate

Question 9

Relationship between sepsis and intercurrent illness

Answer 9

Mimics - flu

Chronic medical conditions - greater risk of sepsis

Can worsen some medical conditions
-AF => fast ventricular response

Can cause myocardial depression

Question 10

Groups at high risk of sepsis

Answer 10

Age extremes
Unwell
Pregnant, postpartum
Surgery or trauma in past 6wks
Neutropenic/IC
Cytotoxic, cancer treatment
Iatrogenic procedures
Malnourished
Compromised organs, chronic conditions

Question 11

Puerperal sepsis
-common infection sites
-causative organisms
-risk factors

Answer 11

Most common - bacterial endometritis

Mastitis, pneumonia, skin, soft tissue infections

Strep pyogenes
Ecoli
S Aureus
Strep pneumoniae
MRSA
Influenza A

Close contact with GAS
Prolonged rupture of membranes
GDM

Question 12

Paediatric sepsis
-how presentations can differ

Answer 12

Floppy, irritable
Vomiting
Rashes
Tachypnoeic
Convulsion
Reduced UOP

Question 13

Neutropenic sepsis
-why
-why is it difficult to detect

Answer 13

Underlying condition or recent treatment with immunosuppressant or systemic anticancer therapy

Sepsis has caused neutropenia

Neutrophils make pus
-lack of neutrophils => no signs on CXR or erythema around wound