A. Intravenous fluids – Explanation
septic from a pneumonia. Sepsis six would need to be performed urgently within the
hour. Among the sepsis six is to give intravenous fluids.
Oral antibiotics would be inappropriate. We need a broad spectrum antibiotic in the
bloodstream as soon as possible thus it needs to be given intravenously.
Chest X-ray would need to be performed but can be done after performing the sepsis
six and stabilising the patient.
SEPSIS
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host
response to infection.
There are a few questions you need to ask when dealing with sepsis:
1. Is the patient acutely unwell or is there any clinical concern?
2. Is the total NEWS score 5 or more?
3. Is there a single NEWS score indicator of 3?
Note: NEWS score stands for National Early Warning Score. It is a score introduced by
the Royal College of Physicians in 2012 and it is used across the NHS to assess
patient’s vitals and observations.
If any of the above questions were yes, then ask yourself, could this be an infection? If
yes, look for any RED FLAGS
Evaluation for ‘Red Flag’ sepsis
Systolic blood pressure < 90 mmHg (or >40 mm Hg fall from baseline)
Heart rate >130 beats/minute
Oxygen saturations < 91% (< 88% in COPD)
Respiratory rate >25 breaths/minute
Responds only to voice or pain/unresponsive
Lactate >2.0 mmol
Urine output < 0.5 ml/kg/hr for ≥ 2 hours
If 1 or more RED FLAGS present → Complete the SEPSIS SIX within 60 minutes
Sepsis Six → Take 3, Give 3
Take 3
o Blood cultures
o FBC, urea and electrolytes, clotting, lactate
o Start monitoring urine output
Give 3
o High flow oxygen
o Intravenous fluid challenge
o Intravenous antibiotics
SEPSIS VS SIRS
| Sepsis | SIRS-Systemic Inflammatory Response Syndrome |
| Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection Septic shock is defined as: Persistently low blood pressure which has failed to respond to the administration of intravenous fluids Evaluation for ‘Red Flag’ sepsis Systolic blood pressure < 90 mmHg (or >40 mm Hg fall from baseline) Heart rate >130 beats/minute Oxygen saturations < 91% (< 88% in COPD) Respiratory rate >25 breaths/minute Responds only to voice or pain/unresponsive Lactate >2.0 mmol Urine output < 0.5 ml/kg/hr for ≥ 2 hours Sepsis Six → Take 3, Give 3 Take 3 Blood cultures FBC, urea and electrolytes, clotting, lactate Start monitoring urine output Give 3 High flow oxygen Intravenous fluid challenge Intravenous antibiotics |
SIRS may occur as a result of an infection (bacterial, viral or fungal) or in response to a non- infective inflammatory cause, for example burns or pancreatitis Requires 2 of the following: Body temperature less than 36°C or greater than 38.3°C Heart rate greater than 90 beats/minute Respiratory rate greater than 20 breaths/minute Blood glucose > 7.7mmol/L in the absence of known diabetes White cell count less than 4 or greater than 12 |
Sepsis has always been hard to define and many diagnostic criterias has been
proposed. There are a few terms of which definitions will help you understand the topic
of sepsis.
How is organ dysfunction identified?
At the bedside, organ dysfunction is identified by an increase in the Sequential (Sepsisrelated) Organ FailureAssessment (SOFA) score of 2 points or more.
What is qSOFA?
In emergency department, or general hospital ward settings, adult patients with
suspected infection can be rapidly identified as being more likely to have poor outcomes
typical of sepsis if they have at least 2 of the following clinical criteria that together
constitute a new bedside clinical score termed quickSOFA (qSOFA):
Respiratory rate of >=22/min
Altered mentation
Systolic blood pressure < =100 mmHg
qSOFA is becoming increasingly popular in UK hospitals to screen for sepsis and in
future, may be more important than NEWS score.
OLD TERMS
“Severe sepsis” are terms of the past that are no longer in use
“SIRS” is also a term that is no longer used clinically 
