Sepsis is life threatening…if concerned, seek advice immediately and ask #coulditbesepsis?
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Clinical Management

sepsis PRIORITIES

Management priorities for sepsis include:
1. Rapid recognition of symptoms and early initiation of treatment including prompt administration of broad-spectrum antibiotics and effective source control to manage the infection.
2. Fluid resuscitation and, if necessary, vasopressor therapy to stabilise and maintain adequate tissue perfusion.
3. Supportive care for organ dysfunction including respiratory and renal support along with continuous monitoring of vital signs and laboratory parameters to guide therapy.
4. Nutritional support and consideration of adjunctive therapies such as corticosteroids.
5. Coordinated multidisciplinary clinical management to optimise outcomes.

Recognition

The onset of sepsis is often insidious with 80% of cases occurring in the community. Patients may appear generally unwell with no definitive cause evident.

Early intervention and prompt treatment is essential as each hours delay in administering antibiotics increases risk of death by close to 8%.

If sepsis can’t be ruled out quickly then commence on a sepsis clinical pathway immediately.

Sepsis occurs as a result of infection, signs suggestive of infection include:

  • Fever and/or rigors
  • Hypothermia
  • Cough, increased sputum production or dyspnoea
  • Abdominal pain or distension
  • Dysuria, urinary frequency, odour
  • New onset confusion or decreased level of consciousness
  • Recent surgery or invasive procedure with cellulitis or wound infection
  • Line associated redness/swelling/pain
  • Painful swollen joint
  • Meningism

SIGNS SUGGESTIVE OF SEPSIS IN ADULTS

Infection confirmed or suspected plus:

  • Temperature > 38.3C or < 36C (normal temperature does not exclude sepsis)
  • Respiratory rate > 20 / minute
  • Heart rate > 90/minute
  • Acute confusion or decreased level of consciousness
  • Hyperglycemia (blood glucose > 7.7 mmol/L in patient without diabetes)
  • Oliguria (urine output less than 0.5 mL/kg/hour)

Signs suggestive of septic shock

Infection confirmed or suspected plus:

  • Mottled or cold peripheries
  • Capillary refill time > 3seconds
  • Systolic BP < 90 mmHg or MAP < 60 mmHg
  • Purpuric rash
  • Arterial or venous lactate > 2 mmol/L
  • Oliguria (urine output less than 0.5 mL/kg/hour

Emergency Triage Education Kit (ETEK) 2nd Ed

The ETEK is a resource for nurses preparing for the emergency department (ED) triage role and for educators. Triage ensures patients with the most urgent clinical need are prioritised for care in the ED. Accurate and consistent triage is the foundation of equitable and safe patient care, as well as effective and efficient use of ED resources.

The ETEK focuses on how to apply the Australasian Triage Scale (ATS) and the knowledge, communication and decision-making skills that underpin this process. The principles of person-centred care are integrated throughout the content, promoting a positive experience for patients, their support people and triage nurses. ETEK, second edition, includes new and revised content on many topics, including decision-making, the effect of bias at triage, communication with patients and support people, care for older people, responding to psychological distress and recognising early signs of sepsis.

ETEK Triage Education Kit

 Sepsis is a medical emergency

Treatment

The accepted principles of treatment include prompt administration of antibiotics (target to administer within one hour of suspecting sepsis), source control, intravenous fluid therapy and organ system support with vasopressor drugs, mechanical ventilation, and renal replacement therapy as required.

Immediate management (Adult):

  • Assess for airway patency and administer oxygen
  • Obtain IV access, blood cultures and baseline blood tests (including lactate)
  • Other diagnostic samples if they will not delay antibiotic treatment (e.g. sputum, urine, pus)
  • Prescribe and administer appropriate antibiotics (should ideally be administered in first hour)
  • Seek early senior clinical advice in all cases
  • IV fluid bolus if patient showing signs of shock/hypoperfusion – 250-500 mL crystalloid (e.g. N/Saline, Hartmanns or Plasmalyte according to local approved protocols) repeated as required
  • Assess for the need for vasopressors to avoid fluid overload
  • Transfer to ICU if transient or no response to treatment
  • Examination for source of sepsis if not already clear
  • Monitor fluid balance and urine output

Resources hub

Access relevant sepsis guidelines, policies and tools in the Resources Hub.

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