Sepsis Assessment and Management

A Paramedic Study Guide

Understanding Sepsis: Definitions

The Sepsis-3 Definitions

The understanding and definition of sepsis have evolved to focus on organ dysfunction as the key identifier of a life-threatening condition, moving away from a purely inflammation-based model.

  • Sepsis: Life-threatening organ dysfunction caused by a dysregulated host response to infection.
  • Septic Shock: A subset of sepsis with profound circulatory, cellular, and metabolic abnormalities, characterized by persistent hypotension requiring vasopressors to maintain a MAP ≥65 mmHg and a serum lactate level >2 mmol/L despite adequate fluid resuscitation.

SIRS vs. Sepsis

It is crucial to differentiate Systemic Inflammatory Response Syndrome (SIRS) from sepsis.

Feature SIRS Sepsis (Sepsis-3 Definition)
Trigger A non-specific, exaggerated defense response to any noxious stressor (infectious or non-infectious, e.g., trauma, burns, pancreatitis). Specifically triggered by a host's dysregulated response to an infection.
Core Component Systemic inflammation. Defined by ≥2 SIRS criteria (Temp >38°C or <36°C; HR >90; RR >20; abnormal WBC). Life-threatening organ dysfunction. An infection is only considered sepsis if it causes organ dysfunction.
Clinical Significance Indicates a systemic inflammatory response but does not necessarily imply a severe condition or organ failure. Always a severe, life-threatening condition with a significant risk of progressing to septic shock and death. Requires immediate, aggressive treatment.

Assessment and Signs of Sepsis

Pre-hospital Assessment Tools: qSOFA

The quick Sequential Organ Failure Assessment (qSOFA) score is a simple bedside prompt to identify patients with suspected infection who are at greater risk for a poor outcome. It is not a diagnostic tool for sepsis but a screening tool for severity.

Allocate one point for each of the following (Score of ≥2 is high risk):

  • Respiratory Rate: ≥ 22 breaths per minute
  • Altered Mentation: GCS < 15
  • Systolic Blood Pressure: ≤ 100 mmHg

Key Signs and Symptoms of Sepsis

Sepsis presents with signs of both infection and organ dysfunction.

In Adults:
  • Altered level of consciousness (confusion, lethargy)
  • Fever or hypothermia
  • Tachycardia and hypotension
  • Tachypnea
  • Pale, cool, or mottled skin
  • Decreased urine output
  • Hyperglycemia
In Children:
  • Cyanosis
  • Non-blanching rash
  • Increased work of breathing (grunting, recessions)
  • Weak, high-pitched, or continuous cry
  • Disinterested, lethargic, or floppy
  • Food refusal

Biomarkers in Sepsis Assessment

  • Lactate: A key biomarker for tissue hypoxia. In sepsis, poor perfusion forces cells into anaerobic metabolism, producing lactate. A level >2 mmol/L indicates significant hypoperfusion and is associated with increased mortality.
  • End-Tidal CO2 (EtCO2): A non-invasive indicator of perfusion and metabolism. In sepsis, low EtCO2 can reflect poor pulmonary perfusion (due to shock) and metabolic acidosis. It is a valuable tool for monitoring CPR quality and response to treatment.

Meningococcal Septicaemia

Pathophysiology and Presentation

Meningococcal septicaemia is a severe, rapidly progressing form of sepsis caused by the bacterium Neisseria meningitidis entering the bloodstream. The bacteria multiply uncontrollably, releasing toxins that cause widespread vascular damage, leading to circulatory collapse and multi-organ failure.

Key Differentiating Sign: While patients present with general signs of sepsis (fever, ALOC, headache, muscle aches), the hallmark sign is a petechial or purpuric non-blanching rash. This rash is caused by bleeding into the skin from damaged capillaries and is a sign of advanced disease.

Pre-hospital Management of Sepsis

The One-Hour Sepsis Bundle

The "Surviving Sepsis Campaign" emphasizes rapid, aggressive intervention. The "one-hour bundle" outlines key actions that must be initiated as soon as sepsis is recognized.

  1. Measure Lactate Level.
  2. Obtain blood cultures before administering antibiotics.
  3. Administer Broad-Spectrum Antibiotics.
  4. Begin rapid administration of 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.
  5. Apply vasopressors if hypotensive during or after fluid resuscitation to maintain a MAP ≥65 mmHg.

Paramedic Management Priorities

  1. Early Identification: Maintain a high index of suspicion. Use qSOFA and clinical judgment to identify at-risk patients.
  2. Oxygen: Correct hypoxia to maintain SpO2 >94%.
  3. IV Fluid Resuscitation: DO NOT DELAY. This is the cornerstone of pre-hospital management. For patients with signs of shock, administer large-volume boluses of isotonic crystalloids (e.g., Normal Saline or Compound Sodium Lactate) as per local guidelines (often 20 mL/kg).
  4. Antibiotics: For suspected meningococcal septicaemia, early pre-hospital administration of antibiotics (e.g., Benzylpenicillin, Ceftriaxone) is a life-saving intervention.
  5. Supportive Care: Administer paracetamol for fever, manage ABCs, and obtain IV/IO access early.
  6. Pre-notification and Rapid Transport: Alert the receiving hospital early to activate their sepsis pathway.