Include in assessment
Sepsis is an infection with a systemic response.
High risk | Moderate to high risk | |
Mental status | Objective altered metal state | History of altered mental state/behaviour or deterioration of functional ability |
Respiratory rate | β₯25 (or new oxygen requirement) | >20 |
Heart rate | >130 | >90 |
Systolic blood pressure | β€90 (or >40 below normal) | β€100 |
Urine output | <0.5ml/kg/hour (or no urine in >18 hours) | <1ml/kg/hour (or no urine in >12 hours) |
Others | Cyanosis or mottled/ashen appearance | Impaired immunity (illness or immunosuppression) |
Reference: NICE βNG51 sepsis: recognition, diagnosis and early managementβ 2017
System | Condition | Signs | Management |
Respiratory | Acute respiratory distress syndrome | Impaired oxygenation, tachypnoea, infiltrates on CXR | Mechanical ventilation |
Cardiovascular | Myocardial dysfunction/failure, hypovolaemia, septic shock | Persistent hypotension (SBP<90) | Inotropes/vasopressors |
Kidneys | Acute kidney injury | Urine output <0.5ml/kg/hour or creatinine >50% baseline | Renal replacement therapy if required |
Liver | Liver dysfunction | Bilirubin β₯35Β΅mol/L and ALP/ALT >2x normal | No specific treatment |
Coagulation | Coagulopathy/disseminated intravascular coagulation | Thrombocytopenia, prolonged PT, low fibrinogen, high D-dimer | Blood products (red cells, platelets, FFP, cryoprecipitate) |
Nervous system | Encephalopathy | New confusion/βGCS | No specific treatment |
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Which are the common bacteria to cause sepsis in immunocompetent patients?
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Which antibiotics would be appropriate for neutropaenic sepsis and why?
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Which types of IV fluid are appropriate for fluid resuscitation for patients with sepsis?
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What is the problem with giving excess 0.9% saline?
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