02. Sepsis

Last updated on 06/07/2022
  • Sepsis is ORGAN DYSFUNCTION due to INFECTION
  • Septic shock hypotension requiring vasopressors to maintain MAP >65 mmHg & a lactate >2 despite volume resuscitation.
  • Mortality >40%

 


Complete Sepsis Screening Form available on wards if infection is considered

  • Identify if INFECTION possible.
  • Identify RISK FACTORS for mortality & sepsis.
    • e.g diabetes, immunocompromise, disease, pregnancy, cancer, surgery, age
  • Abnormal EWS should trigger investigations for sepsis.
  • Screen for ORGAN DYSFUNCTION.

 


Clinical Signs of Sepsis

↓ BP, ↑ HR, narrow pulse pressure, poor skin perfusion, ↑ CRT,
Temp ≥38 or ≤36

Labs: WCC >12 or <4 or >10% immature bands
Rising ↑Cr/AKI & ↑PT/INR & ↓Plts

Organ dysfunction

Alt. mental status

Hypoxia: High lactate >2 = tissue hypoperfusion

Oliguria: <0.5mls/kg = vol. depletion or renal failure

Hypotension: systolic <100 or ↓ from baseline of >40

AKI or acute liver dysfunction

​START THE SEPSIS SIX AND REMEMBER TO ASK FOR SENIOR INPUT


TAKE 3 GIVE 3

Blood cultures prior to abx
Lactate >2 (repeat in 2-4hrs)
Measure urine output

Abx (broad spectrum)
Fluids (give 30mls/kg NaCl over 3hrs if ↓ BP or lactate >4)
O2 (Target SpO2 94-98%, unless COPD)

 

  • If CCF is an issue: Boluses of 250-500mls and regularly reassess fluid balance
  • If still hypotensive during/ after resuscitation: Give vasopressors to maintain MAP≥65 and >30mls/per kg crystalloid pending fluid responsiveness