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Home | Articles | Infectious Diseases | Suspected Sepsis

Suspected Sepsis

Last updated 5th August 2024

Introduction

  1. Ask yourself “Could this patient have sepsis?
  2. Use ABCDE approach if patient looks unwell
  3. Do the Sepsis Six if you think sepsis is likely
  4. Use Sepsis Record below

Be Aware of Increased Sepsis Risk With High Risk Patient Groups

  1. Older age >65
  2. Immunosuppression due to impaired immune system, illness or drugs
  3. Recent surgery
  4. People with indwelling lines or catheters
  5. Diabetes
  6. People who inject drugs (PWID)
  7. Pregnancy (NEWS2 should not be used in pregnancy)
  8. Neurodisability

 

 

The following tables aren’t absolutely necessary for you to recognise and manage sepsis successfully, but will be of interest to those seeking more detail and a deeper dive.

Sequential Organ Failure Assessment (SOFA) Score*

Organ System
Measurement		SOFA Score
01234
Respiration
PaO2(kPa)/FiO2
(expressed as a fraction eg 60%=0.6)		>53.340 - 53.326.7 - 4013.3 - 27.6 (with resp support)<13.3 (with resp support)
Coagulation
Platelets x 103/mm3		Normal<150<100<50<20
Liver
Bilirubin, micromol/L		Normal20-3233-101102-204>204
Cardiovascular
Hypotension		NormalMAP<70 mmHgDopamine ≤5 or dobutamine (any dose)**Dopamine >5 or epinephrione ≤0.1 or norepinephrine ≤0.1Dopamine >15 or epinephrine >0.1 or norepinephrine >0.1
Central Nervous System
Glasgow Coma Scale		Normal13-1410-126-9<6
Renal
Creatinine, micromol/L or Urine output		Normal110-170171-299300-440 or <500mL/day>440 or <200mL/day

*Source: Vincent et al., 1996 – units for Respiratory, Liver & Renal adapted to reflect local parameters.

** Adrenergic agents administered for at least 1 hour (doses given are in microgrammes/kg/min).

MD+CALC SOFA Score Calculator

Clinical Decision Support Framework for Initial Evaluation of Sepsis in Adults ≥16 Years

Academy of Medical Royal Colleges (AoMRC)

Vital SignsVital Signs: NEWS-2 'Physiology First'01-45-6≥7
Initial AssessmentHistory, examination, lab resultsIf clinical or carer concern about a serious diagnosis, continuing deterioration, neutropenia, or blood gas/lab evidence of organ dysfunction, including elevated serum lactate, upgrade actions at least to next NEWS-2 level.
Consider influence of comorbid disease, frailty and ethnicity on NEWS-2, and patient preferences for treatment intensity, limits, end-of-life care
Initial (Generic) ActionsMonitoring and escalation planStandard Observations- Registered nurse review <1h
- Obs 4-6 hourly if stable
- Escalation if no improvement		- Obs hourly
- Review <1 hr by clinician competent in acute illness assessment
- Escalate if no improvement		- Obs every 30 min
- Review <30 min by clinician competent in acute illness assessment
- Senior doctor review <1 hr if no improvement: refer to Outreach or ICU
Initial treatment of precipitating conditionsStandard care<6hr<3hr<1hr
Likelihood of Infections and Specific ActionsUnlikelyStandard careReview daily and reconsider infection if diagnosis remains uncertain
PossibleReview at least daily<6hr
- Source identification & control plan		<3hr
- Microbiology tests
- Antimicrobials: adminster or revise
- Source identification & control plan

48-72 hr
- Review antimicrobials with ID/micro/senior clinician		<1hr
- Microbiology tests
- Antimicrobials: administer or revise (broad-spectrum if causative organism uncertain)

>3h
- Source identification & control plan

48-72 hr
- Review antimicrobial with ID/micro/senior clinician
Probable or definite<6hr
- Source identification & control plan		<6hr
- Microbiology tests
- Antimicrobials: administer or revise
- Source identification & control plan
- D/w ID/micro if uncertain & review

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Content by Dr Ali Atwi & Dr Sharon Irvine