Risk assessment of adults with suspected sepsis:
If patients are suspected to have sepsis, they should be screened to be either high risk or moderate risk sepsis. This will help identify what treatment they need and in what time frame. The risk assessment should be completed by an appropriately trained clinician eg FY2+ doctor or equivalent.
Treating sepsis:
If you suspect sepsis, you should complete the sepsis 6 within the first 1 hour.
The sepsis 6
The sepsis 6 is an evidence based care bundle designed for any healthcare professional to instigate as part of the early goal directed therapy for sepsis. It has recently been updated to reflect best current evidence.
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Not all patients with suspected sepsis will need the ‘sepsis 6’ urgently.
A senior decision maker may seek alternative diagnosis / de-escalate care.
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Administer oxygen to achieve saturations within target range.
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Blood cultures, blood glucose, lactate, FBC, U&Es, CRP and clotting. Lumbar puncture if indicated.
When taking bloods cultures it is now recommended to take two sets, with each bottle containing at least 10mls of blood.
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Start broad spectrum therapy based on local policy. Consider the need for imaging / specialist review.
If source amenable to drainage ensure achieved as soon as possible but always within 12 hours.
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Give in divided fluid boluses of 500mls over 20-30 minutes.
Balanced crystalloid such as Hartmanns.
Amount of fluid resuscitation will be patient specific. 30mls/kg is a guide.
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Use NEWS
Measure urine output, this may require a catheter
Repeat lactate at least hourly if initial lactate elevated or change in clinical condition.