🚨 Sepsis

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Early recognition and prompt management are crucial to reduce mortality and morbidity. It is a medical emergency requiring immediate attention.

Look for new altered mental state, respiratory rate ≥25/min or new need for oxygen to keep SpO2 ≥92% (or ≥88% in COPD), heart rate ≥130/min, systolic blood pressure ≤90 mmHg or fall >40 mmHg from normal, new anuria or urine output <0.5 ml/kg/hr for >2 hours, non-blanching rash, or mottled/ashen/cyanotic skin. Consider infection source. Use NEWS2 score for objective assessment.

A: Assess airway patency, listen for stridor. B: Check respiratory rate, SpO2, work of breathing. Administer high-flow oxygen. C: Assess heart rate, blood pressure, capillary refill time, urine output. Insert two large-bore cannulae. D: Assess conscious level (AVPU/GCS), pupil size/reactivity, blood glucose. E: Check temperature, skin for rashes/mottling, identify potential infection source.

Deterioration in conscious level (e.g., GCS drop by 2 points), persistent hypotension despite fluid resuscitation, increasing oxygen requirements, worsening acidosis on blood gas, new onset arrhythmia, or oliguria/anuria despite adequate fluid challenge. These indicate progression to septic shock or worsening organ dysfunction.

Bedside: Capillary blood glucose, urine dipstick, NEWS2. Bloods: Full blood count, C-reactive protein, urea and electrolytes, liver function tests, lactate, blood cultures (before antibiotics if possible), arterial blood gas. Imaging: Chest X-ray, urine cultures, wound swabs, or other relevant cultures based on suspected source.

Administer high-flow oxygen to maintain target saturations. Give intravenous fluid resuscitation with crystalloids, guided by haemodynamic response. Administer broad-spectrum intravenous antibiotics promptly after blood cultures are taken. Consider source control, such as drainage of abscesses or removal of infected lines. Monitor vital signs and urine output closely.

Any patient meeting sepsis criteria should trigger senior review. Failure to respond to initial fluid resuscitation, persistent hypotension, increasing lactate, new organ dysfunction, or a NEWS2 score of 7 or more requires immediate escalation to a senior registrar or consultant, and consideration for critical care input.

The 'Sepsis Six' bundle (oxygen, cultures, antibiotics, fluids, lactate, urine output) should be initiated within one hour. Remember to always take blood cultures BEFORE antibiotics, unless this causes significant delay. A rising lactate is a key indicator of tissue hypoperfusion and poor prognosis. Always consider non-infectious causes of SIRS.