Sepsis

Sepsis is a life-threatening reaction to infection. The body’s immune system overreacts causing damage to tissues and organs. It has a high risk of mortality and is a common cause of patient deterioration in the inpatient setting.

Septic shock is a subset of sepsis where the circulatory and cellular/metabolic dysfunction is associated with a higher mortality. In a patient who has been adequately fluid resuscitated, it is defined as the presence of:

  • Persistent hypotension requiring vasopressors to maintain MAP greater than or equal to 65 mm Hg, and/or

  • Lactate ≥ 2 mmol/L

National early warning score and sepsis

It is a national recommendation to screen for sepsis using the National Early Warning Score. When a patient has a NEWS 5 or above or a single RED score >3, we should consider sepsis. However, not all patients with a raised NEWS will have sepsis so it is important that we rule out other causes of deterioration. Patients with suspected sepsis will need close monitoring.

How to spot sepsis in adults

Slurred speech or confusion

Extreme shivering or muscle pain

Passing no urine (in a day)

Severe breathlessness

It feels like you are going to die

Skin mottled or dicoloured

If your patient has a NEWS ≥ 5 think could this be sepsis?

If your patient has a NEWS ≥ 5 think could this be sepsis?

Be aware of patients who are at a higher risk of developing sepsis:

  • The immunocompromised (this may be due to medication or disease)

  • The very young (under 1 year)

  • The elderly (over 75 years), or people with significant frailty

  • Woman who are pregnant or have given birth, miscarried or had a termination of pregnancy in the last 6 weeks

  • People who have had surgery, or other invasive procedures in the past 6 weeks

  • People who inject drugs intravenously

  • People with any breach of skin integrity (for example cuts, burns, blisters or skin infections)

  • People with indwelling lines or catheters

Suspect neutropenic sepsis in people who become unwell and have had recent anti-cancer treatment, those who have received or are receiving immunosuppression for other reasons or based on clinical assessment, history or conditions that may cause neutropenia.

Common sources of infection:

  • Sepsis Assessment

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  • Sepsis Management

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