Early recognition of sepsis ⚠️

Risk Factors for Sepsis

  • Previous sepsis
  • Re-presentation unwell within 48 hours
  • Chronic illness especially diabetes
  • Immunocompromised (weak immune system)
  • Alcohol misuse
  • Recent surgery or implantable device/valve

Early use of antibiotics is critical in sepsis — early medical consult

  • Where available follow local sepsis pathway
  • Antibiotic choice based on regional sensitivities and likely body system
  • Take blood and urine for culture before giving antibiotics where possible — for adults collect 2 sets of cultures from 2 different sites
  • If allergy to penicillin — medical consult before giving antibiotics
  • If unknown or undifferentiated sepsis — give IV gentamicin, flucloxacillin, ceftriaxone first AND if available vancomycin as a single slow infusion — dose and infusion rate

After treatment — re-assess for response

  • Repeat Remote Early Warning Signs (REWS) observations often to detect deterioration
    • Every 30 minutes if medium risk
    • Every 15 minutes if high risk

Assessment

Adult assessment
  • Person looks unwell or presents with acute problem
  • Calculate Remote Early Warning Score (REWS) using appropriate table —Table 1.1

OR if woman more than 20 weeks pregnant — Table 1.2

  • Score each line individually. Then add scores for REWS

THEN  follow Flowchart 1.1 for management

Beta-blockers reduce heart rate and can confuse REWS score

Table 1.1 Adult REWS (13 years and over)

Table 1.2 Obstetric REWS (more than 20 weeks pregnant)

Highlighted text updated June 2024

Paediatric assessment
  • Assess appearance, work of breathing and circulation
  • Assess level of respiratory distress — Table 1.3
    • Assess each category individually
    • Use the highest grade in any category when calculating REWS
  • Calculate REWS by age — use age appropriate table 
  • Score each line individually THEN add scores for REWS

THEN follow Flowchart 1.1 for management

Table 1.3 Assessing respiratory distress — child 0–12 years

Table 1.4 Paediatric REWS — 0–3 months

Table 1.5 Paediatric REWS — 4–11 months

 

Table 1.6 Paediatric REWS — 1–4 years

! Table 1.6 updated June 2024

Table 1.7 Paediatric REWS — 5–12 years

Management

Flowchart 1.1 Management based on risk level

Flowchart updated June 2024