Sepsis diagnosis and management

A staggering 37,000 deaths a year are caused by Sepsis in the UK. Worldwide this figure increases many times over. It kills more people than some cancers – so why is it so high? Part of the problem is the initial recognition and management of the disease. So what do we need to know for Sepsis diagnosis and management?

What is sepsis?

Sepsis has many names; you may hear it called Sepsis, Septicaemia, Blood poisoning or Septic Shock. What happens is that the body becomes so overwhelmed in its attempts to fight an infection that organs begin to fail. Within hospitals there is now an increase in the education of nurses and doctors so that this condition can be recognised early and treated more effectively. There are things we can do to help in the community.

How is it recognised?

The signs are a site of infection, for example signs of a chest infection, urinary infection or a wound that looks infected, along with signs of infection which are changes in temperature, pulse, respiratory rate, mental state, white cell count and glucose level.

Temperatures above 38.3°c or below 36°c, pulse rates above 90 beats/min and respiratory rates >20/min are considered signs of infection, along with a very low (<4) white cell count or very high (>12×109 /L), an acute change in mental state or a blood glucose above >6.6mmol/L. Two of these signs plus a site of infection is diagnosed as Sepsis.

It’s also likely that the person will have begun to feel generally unwell. This is where if you’re working in the community you have a part to play. Regardless of location changes in temperature, pulse, respiratory rate and mental state are recognisable and recordable; it’s the measurement of blood sugar and white cell count that requires access to more specialist equipment.

What can we do in the community?

We can help to raise awareness amongst our network, whether that’s friends, family or patients, and let them know that if they should begin to feel generally unwell with ‘flu-like’ symptoms and have an infection they should seek advice. This can be via 111, a local walk-in centre, their practice nurse or GP or if it’s a dental problem their dentist.

As health professionals working in the community and treating patients with localised infections we need to advise them on when to seek additional advice; for example, if the infection isn’t settling or they feel generally unwell with a raised temperature.

Surviving Sepsis Campaign

There are campaigns to raise awareness of Sepsis such as The Surviving Sepsis campaign.

I want to focus on what is termed the Sepsis 6 but you can find more information on treatment bundles here. I’ve recently heard of some good ways to help you remember the Sepsis 6 and these are:-
• FABULOS, which stands for fluids, antibiotics, blood cultures, urinalysis and urinary catheter, lactate, oxygen = Sepsis 6.
• ‘Give 3 and take 3’ ie give oxygen, fluids, and antibiotics and take blood cultures, lactate and urine.
• 3 matched pairs – ‘oxygen in – blood gas out’, ‘blood cultures out – antibiotics in’, ‘fluids in – urine out’

It doesn’t matter which method you use to help you remember, what matters is that we do remember.

Obviously in the community we probably won’t be able to do this. What we can do is recognise that our patient may be developing Sepsis and signpost them onto other services as needed.

I hope you found this useful, please share it so more people will be aware of what to look out for. If you have any experiences you’d like to share please comment below.

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