Sepsis – A practical Approach

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Introduction

Despite the challenges of precise definitions of sepsis, a practical way of initially approaching the problem is to address the specific clinical issues and identify justifiable reasons for a meaningful intervention namely.

1. Antibiotic administration
2. Fluid Resuscitation
3. Ongoing vasopressor support
4. Surgery

There are other aspects of care including organ support such as ventilation and dialysis that are not within the realm of practice of most practitioners and require discussion with ICU.

Antibiotics

Prompt (within 1 hour) and appropriate antibiotics should be given if:

1. Any patient with fever or raised inflammatory markers and immuno-compromise e.g chemotherapy patients
2. There is good clinical, radiology or microbiological evidence of source of infection e.g. fever or raised inflammatory markers with cellulitis, consolidation on CXR, positive urine culture
3. Any suggestion of SIRS criteria and the patient has obvious signs of shock even if infection is not evident

Fluid resuscitation – 10-30ml/kg

1. If the patient has obvious signs of shock
2. As an initial trial to correct early signs of shock

Vasopressor

1. If there is evidence that the patient has shock and is clearly fluid overloaded
2. There is persistent evidence of shock after 20-30ml/kg of fluid

Surgery

1. If there is clinical or imaging evidence of abscess, infected collection or deep tissue infection

if inadequate evidence of any of these indications then withhold therapy and monitor the patient