Sepsis is a life-threatening response to infection. Did you know that more than 18 000 Australians suffer from sepsis every year with more than 5000 deaths a year; this is twice the number of deaths due to traffic accidents.

50% of the sepsis related deaths in children occur in the first 24 hours. 60% of Australians have never heard of sepsis with only 14% being able to name the symptoms with newborns and young children most vulnerable to sepsis. (CEC QLD 2020).  Not only does sepsis come with a high mortality rate, but many patients who do survive are left with life changing effects such as amputations, sensory losses, chronic pain, fatigue and post-traumatic stress syndrome.

Early recognition and management of sepsis saves lives. So how do we recognise sepsis?

 The qSOFA score is a bedside tool that clinicians can use to identify possible sepsis in patients with suspected infections. Patients who demonstrate two or more of these symptoms are at greater risk of deterioration with a poor outcome outside the ICU.  The qSOFA uses three criteria of: 

If these criteria are applied to patients with known or suspected infections, then the question should be asked "Could this be Sepsis?" 

Do you want to know the risk of a bad outcome for your patient with sepsis? Use the qSOFA calculator at www.qsofa.org  

 So why is sepsis such a problem?

In response to infection the body’s immune system responds.  An inflammatory response to infection starts the clotting cascade with an increase in coagulation and decrease in fibrinolysis.  This impedes circulation with reduced blood flow and oxygen to cells causing organ dysfunction.  

Source: ( Eli Lilly and Company: Surviving Sepsis Education Program. Adapted from Bernard et al 2001) 


 The Inflammatory response to infection

 As the patient experiences tissue hypoxia, lactate levels will rise in response to anaerobic metabolism.  This is why lactate is often considered a marker of sepsis.  However it is important to remember that elevated lactate is seen in many clinical conditions, and should not be used as ONLY a measure of sepsis.  

Lactate can be a useful measure to assess for a metabolic response to septic shock and guide treatment.  Patients with septic shock can be identified as those patients with persistent hypotension despite adequate fluid resuscitation.  Septic patients with a MAP ≤ 65mmHg and a serum lactate > 2mmol/L now have a mortality rate >40%.  These patients will need vasopressor support. 

How do we treat?

Source control is the cornerstone of sepsis management, the only way to ‘cure’ sepsis is to identify and remove the source.  With consideration to antimicrobial stewardship, the early administration of antibiotics is thought to reduce mortality.  The gold standard is to administer antibiotics within an hour of signs of sepsis, with every hour antibiotics are delayed, mortality increases by 8%.  Antibiotics should be reviewed every 24hrs.  

Want to know more?

Tune in to our 2021 Webinar series starting on the 19th April where we will be reviewing coroners cases related to sepsis.  Register for your free place here https://medcast.com.au/critical-care

If you found this topic of interest, you will enjoy the learning in our programs focusing and managing the critically ill patient. Register for our Recognition of Clinical Deterioration and ALERT courses here: https://medcast.com.au/critical-care

References and Additional Reading:

https://www.australiansepsisnetwork.net.au/ssnap

https://www.cec.health.nsw.gov.au/keep-patients-safe/deteriorating-patient-program/sepsis

https://clinicalexcellence.qld.gov.au/resources/sepsis

https://sepsistrust.org/professional-resources/

https://www.sccm.org/SurvivingSepsisCampaign/Guidelines

Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJ Jr; 2001. Recombinant human protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study group. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. https://doi.org/10.1056/nejm200103083441001
 
Dellinger R., Schorr C., Levy M., 2017 A users’ guide to the 2016 Surviving Sepsis Guidelines Intensive Care Med 43:299-303 https://doi.org/10.1007/s00134-017-4681-8

Dellinger, R.P., Levy, M.M., Rhodes, A. et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012. Intensive Care Med 39,165–228 (2013). https://doi.org/10.1007/s00134-012-2769-8

Raith EP, Udy AA, Bailey M, et al. 2017 Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit. JAMA; 317: 290-300 https://doi.org/10.1001/jama.2016.20328

Rob G. H. Driessen, Nanon F. L. Heijnen, Riquette P. M. G. Hulsewe, Johanna W. M. Holtkamp, Bjorn Winkens, Marcel C. G. van de Poll, Iwan C. C. van der Horst, Dennis C. J. J. Bergmans & Ronny M. Schnabel (2021) Early ICU-mortality in sepsis – causes, influencing factors and variability in clinical judgement: a retrospective cohort study, Infectious Diseases, 53:1, 61-68, DOI: 10.1080/23744235.2020.1821912

Rudd KE, Johnson SC, Agesa KM, et al. 2020 Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet 395: 200-211 https://doi.org/10.1016/S0140-6736(19)32989-7 

Singer M, Deutschman CS, Seymour CW, et al. 2016 The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA; 315: 801-810 https://doi.org/10.1001/jama.2016.0287

{{commentCount}} comment(s). You must be logged in and AHPRA verified to view and comment. LOG IN

Susan Helmrich

Susan is the Head of Nursing Education at Medcast.

DipAppScNsg, BN, CritCareCert, CoronaryCareCert, TraumaNsgCareCert, CertIV(TAE), MN(Ed), and GradCert(Ldrshp & Mgt).

The latest healthcare news from medcast

Mobile Stroke Unit Success in Melbourne
Mobile Stroke Unit Success in Melbourne

The opportunity to reduce time to thrombolysis or EVT has significantly reduced the risk of disability for patients who were were able to access the MSU, and improved transfer times to appropriate EVT hospital centres.

Navigating the Unfamiliar World
Navigating the Unfamiliar World

So much has been written about fear, anxiety and stress in the COVID era. And I certainly can identify with much of it. For me, however, it’s a lot more complex than just these emotions. I find I don’t recognise the world today. Looking around, o...

Piano lessons, and 5 ways to Wellbeing with Hot Topics delegates
Piano lessons, and 5 ways to Wellbeing with Hot Topics delegates

One of the highlights of my week is my piano lesson, now by Zoom of course, with my teacher John. I took up piano at the age of 55, never having had a music lesson in my life...

Tip your HAT to Sepsis
Tip your HAT to Sepsis

Sepsis is a life-threatening response to infection. Did you know that more than 18 000 Australians suffer from sepsis every year with more than 5000 deaths a year; this is twice the number of deaths due to traffic accidents.

Contemporary challenges in responding to domestic violence
Contemporary challenges in responding to domestic violence

The complexity of the intersection between mental health, trauma and domestic violence poses significant challenges for health professionals. Increasing recognition of the limitations of mainstream healthcare systems’ response to domestic violence...

Food Allergies and Current Infant Feeding Guidelines in Australia
Food Allergies and Current Infant Feeding Guidelines in Australia

Australia saw a five fold increase in hospitalisation with anaphylaxis between 1995 and 2005, which sadly also saw an increase in the number of fatalities from anaphylaxis. The new infant feeding guidelines have had very positive results, with man...

Surviving Another Stressful Year
Surviving Another Stressful Year

Because COVID is not over yet it’s probably worth our thinking again about how we can optimise the benefits of our downtime, as well as manage the stressors at work.

PCOS in General Practice - Podcast
PCOS in General Practice - Podcast

‘Women’s Health for male GPs can be somewhat tricky’ Dr Rowan Vickers

Ventilation and Compressions Ratios in Paediatric Resuscitation
Ventilation and Compressions Ratios in Paediatric Resuscitation

2020 ILCOR guidelines emphasise the importance of higher ventilations in paediatric resuscitation. This reflects the higher oxygen requirements of children which is evident in their higher baseline respiratory rate.

2020, a year in review: Pam Withey
2020, a year in review: Pam Withey

We've asked some Community of Practice members to tell us about what 2020 has meant to them. Some things may surprise you...

Lynch Syndrome - Podcast
Lynch Syndrome - Podcast

Is it just bad luck, or could it be Lynch Syndrome?

Magic Myokines - Physical Activity and Cancer Podcast
Magic Myokines - Physical Activity and Cancer Podcast

In this podcast Dr Alison Vickers and Professor David Jenkins discuss the role of physical activity in preventing and reducing the impact of cancer.

2020, a year in review: Dr Srishti Dutta
2020, a year in review: Dr Srishti Dutta

Back at the beginning of 2020 we asked people we know to tell us how they were coping with the pandemic. We asked them 3 questions. Here’s how one Australian GP with far-flung connections is answering these questions now:

Whooping Cough - Video
Whooping Cough - Video

Ranjith, a 48 year old male, presents to you with an annoying persistent cough. He has had cold like symptoms and low grade fever for a week.

Preoperative Assessment and Mallampati Scores
Preoperative Assessment and Mallampati Scores

The Mallampati Score or Classification is a simple and easy to use tool that assists in predicting difficult endotracheal intubation.

Better Together: GP Supervisor Education
Better Together: GP Supervisor Education

Q: What do fish and chips, Batman and Robin, and country and western music have in common?

2020, a year in review: Dr Carol Newall
2020, a year in review: Dr Carol Newall

We've asked some Community of Practice members to tell us about what 2020 has meant to them. Some things may surprise you...

2020, a year in review: Dr Genevieve Yates
2020, a year in review: Dr Genevieve Yates

We've asked some Community of Practice members to tell us about what 2020 has meant to them. Some things may surprise you...

Long COVID-19
Long COVID-19

Do we really need another syndrome?! Isn’t it just the same as recovery from any other infectious disease?

Keys to prevention in mental health - Alexithymia
Keys to prevention in mental health - Alexithymia

I first encountered the concept of alexithymia when I worked with people suffering from eating disorders. Many people experiencing eating disorders have great difficulty identifying and naming their own emotions.

Join Medcast. It's free and you'll get instant access to essential healthcare news, research and more.

Already a member? Log In