Sepsis

A life threatening organ dysfunction caused by a dysregulated host response to infection

Utilises Quick SODA (qSOFA) scoring system - based on

• RR
• altered mental state
• systolic BP

Septic shock is a subset of sepsis. Profound circulatory, cellular and metabolic abnormalities

• Vasopressor requirement to maintain a MAP >65
• serum lactate level >2mmol/L

Causes/Factors

• < 1 year and > 75 years
• very frail people
• recent trauma or surgery or invasive procedure
  • within 6 weeks
• impaired immunity due to
  • illness or
  • drugs
  • steroids, chemotherapy or immunosuppressants
• indwelling lines / catheters
• intravenous drug misusers
• any breach of skin integrity
• cuts, burns, blisters or skin infections

Recognition

• Signs + symptoms of infection
• Be aware that people may have non-specific symptoms
• Pay particular attention to concerns expressed by the person/family
• High NEWS2 score

High Risk Criteria

• Altered mental status
• RR >25
• New need for Oxygen
• HR >130
• Systolic <90 or 40 below normal
• Not passed urine in pervious 18 hours
• Mottled or ashen appearance
• Cyanosis
• Non-blanching rash

Diagnostic Tests

• FBC, CRP, U&E, urine culture, blood culture
• ABG or VBG
• Blood sugar

Management

• Prompt management within 1 hour
• Sepsis6

BUFALO

• Blood cultures and septic screen
• Urine output - monitor hourly
  • U&Es urine culture
• Fluid resuscitation
  • as clinically indicated
• Antibiotics IV - LTHT guidelines (tazocin? 4.5 g every 8 hours; increased if necessary to 4.5 g every 6 hours)
• Lactate measurement - from arterial or venous blood gas
• Oxygen to correct hypoxia

Hypovolaemia can be

• True hypovolaemia - when the rate of fluid loss exceeds net intake
  • Haemorrhage
  • Vomiting
  • Diarrhoea
• Relative hypovolaemia - when there is a decrease in the effect circulating volume
  • Sepsis - vasodilation