Emergency Medicine

• Sepsis


  Life-threatening organ dysfunction due to a dysregulated host response to infection
• Sepsis clinical criteria


  • Organ dysfunction is defined as an increase of 2 points or more in the Sequential Organ Failure Assessment (SOFA) score
  • For patients with infections, an increase of 2 SOFA points gives an overall mortality rate of 10%
• qSOFA ("HAT")


  Prompt identification of patients with suspected infection who are likely to have a prolonged ICU stay or to die in the hospital, i.e. 2 or more of: Hypotension (SBP less than or equal to 100 mmHg), Altered mental status (any GCS less than 15), Tachypnoea (RR greater than or equal to 22)
• Septic shock


  A subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality
• Septic shock clinical criteria


  • Sepsis and (despite adequate volume resuscitation) both of: Persistent hypotension requiring vasopressors to maintain MAP greater than or equal to 65 mm Hg, and Lactate greater than or equal to 2 mmol/L
  • With these criteria, hospital mortality is in excess of 40%
• The term "severe sepsis" is no longer in use
• Early intervention in ED reduces mortality in patients with sepsis and septic shock


  1. Aggressive resuscitation with iv fluids, vasopressors and inotropes should start early

  2. Close monitoring of systolic BP, lactate and UO

  3. Board spectrum antibiotics should be administered within one hour of recognition of sepsis
• SOFA score components


  • Respiratory system (Pao2/FiO2)
  • Nervous system (GCS)
  • Cardiovascular system (MAP)
  • Liver (bilirubin)
  • Coagulation (platelet)
  • Kidneys (creatinine)
• Principles of Sepsis Management

  • Early recognition
  • Early resuscitation with fluids and inotropes
  • Early antibiotics
  • Early source control
  • Close monitoring