Life-threatening organ dysfunction from a dysregulated response to infection
Expansion
Definition: life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock adds persisting hypotension requiring vasopressors with a lactate above 2 despite adequate fluid.
Screening: qSOFA (any two of respiratory rate 22 or more, altered mentation, systolic blood pressure 100 or less) or a NEWS2 score.
Sepsis Six, within one hour:
Three in
- Oxygen to target saturations
- Intravenous fluids
- Antibiotics, broad spectrum, intravenous
Three out
- Blood cultures (before antibiotics if it does not delay them)
- Lactate and blood tests
- Urine output monitoring
Red flags: systolic pressure under 90, lactate above 2, reduced consciousness, non-blanching rash, respiratory rate 25 or more, oxygen needed to maintain saturations, not passing urine for 18 hours.
Two cautions worth carrying: the elderly and immunosuppressed may be afebrile or hypothermic and present only with confusion or falls; and lactate is the most useful single marker of severity and of response, so it should be repeated.