Identification and management of sepsis

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Sepsis can rapidly lead to acute physiological deterioration with the risk of multiple organ failure and death. Early identification of sepsis with appropriate intervention has been shown to improve survival.

The Sepsis Six bundle targets early treatment of established sepsis. 

Could the patient's presentation or deterioration be due to a bacterial infection? If so what is the site of infection? If they have a NEWS of 5 or more, or qSOFA of 2 or more, consider using Sepsis Six outlined below.

Diagnosing SepsisSystemic Inflammatory Response Syndrome (SIRS) criteria:
  • Temperature: <36oC or >38oC
  • Pulse: ≥ 90 beats per minute
  • White Blood Count <4 or >12 cells/mm3
  • Respiratory Rate >20 breaths per minute OR pCO2 <4 kPa

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The qSOFA score (quick Sepsis-related Organ Failure Assessment) is a bedside prompt that may identify patients with suspected infection who are at greater risk of a poor outcome.

Assign one point each for:

  • low blood pressure (SBP≤100 mmHg)
  • high respiratory rate (≥22 breaths per  min)
  • altered mentation (Glasgow coma scale<15)

2 or more points near the onset of infection identify patients with worse outcomes than those with uncomplicated infection.

Management of Sepsis - Sepsis Six

Within 1 hour of inclusion criteria being met, do ALL of the following:

1.Take blood cultures and consider source control
2.Measure lactate.
3.Measure urine output accurately.
4.Give oxygen – target SpO2 94-98% (risk of hypercapnic respiratory failure target SpO2 88-92%).
5.Give IV antibiotic according to local guidelines.
6.Give IV fluid challenge for hypotension or lactate >2mmol/L (500 ml stat). May be repeated if clinically indicated, do not exceed 30ml/kg.
Signs of organ dysfunction (severe sepsis)

Any one of the following as evidence of new onset organ dysfunction:

    • New AKI or oliguria
    • Altered mental state (new onset)
    • Coagulopathy
    • Platelets < 100 x 10 9/l
    • Increased oxygen requirement 
    • Serum lactate ≥ 2 mmol/l
Septic shock: the need for vasopressors and a serum lactate ≥ 2mmol/L