Sepsis

Primary survery

Breathing: RR, SpO2, listen for breath sounds, provide oxygenation as needed

Circulation:

Airway: Is the airway intact?

Disability: BGL, AVPU/GCS, pupils, consider meningitis sx

DRS: Contact ED consultant

Exposure: Temp, examine skin + abdo

Definition

Clinical criteria

Sepsis 3: qSOFA

RR > 22

SBP: <100

Positive: >/=2 findings

GCS < 15

Sepsis 2: SIRS

WBC: < 4000 or > 12000

HR: >90

RR: >20

Temp: < 36 or > 38

Positive: >/=2 findings

Investigations

Severe sepsis

Sepsis: Dysregulated host response to an infection in the body

Sepsis + organ hypoperfusion/dysfunction

Lactate level ≥ 4 mmol/L is considered diagnostic

Septic shock

Sepsis related hypoperfusion not responding to adequate fluid resus and requiring vasopressors

Fluids: Initial bolus (20mls/kg stat, repeat if needed), monitor input and output, consider IDC, UA

Bloods (FBC, UEC, VBG/ABG, coags, group and save, cultures x 2, CRP/PCT, LFTs)

Fluid resus (if no response after 1L of fluids consider vasopressors

2x IV cannulas

Abx:

HR, BP, cap refill, listen to heart sounds

Within 1 hour if severe sepsis, otherwise within 2 hours

Gentamicin + flucloxacillin/cephazolin +/- vancomycin (if MRSA suspected)

ECG

CXR

Cultures from other sites

Further management

Repeat lactate at 4 and 8 hours

Beware of APO

Continue monitoring

Check results and change Abx as appropriate