Sepsis: Signs, Symptoms and qSOFA
How does a patient die from sepsis? What happens to their body, vessels and organs?
When someone experiences an infection, every cell of their body is compromised. With the right clinical assessment skills and knowledge it is possible to identify sepsis early and save lives.
What is Sepsis?
Sepsis is an overactive response to an infection causing the body to damage its own organs and tissue (Sepsis Alliance 2017).
Sepsis can be caused by any infectious pathogen (WHO 2018).
When chemicals are released from the infection into the systemic circulation, the body then recognises the foreign body and the inflammatory process begins, leading to coagulation (blood clotting) and hypoperfusion (decreased blood supply to the organs). This impaired blood supply starves the organs of oxygen, causing significant damage (NIH 2019).
Sepsis is a life-threatening medical emergency that can lead to septic shock, multiple organ failure and potentially death. It affects approximately 30 million people globally, every year, resulting in about 6 million fatalities, and is one of the leading causes of hospital patient death (WHO 2018; Nursing Times 2014).
Who is at Risk of Sepsis?
Sepsis doesn’t discriminate; anyone from babies to older adults, males to females, can develop it. It is, however, more common and dangerous in those with weakened immune systems, older adults with multiple comorbidities, the very young, and individuals who are already unwell (Mayo Clinic 2018).What Are the Signs and Symptoms of Sepsis?
The many signs and symptoms of sepsis include abnormalities in the individual’s body temperature, heart rate, respiratory rate, hypotension and white blood cell count, in addition to hypoxaemia, oliguria, lactic acidosis, elevated liver enzymes and altered cerebral function (Sepsis Alliance 2018).
The Importance of Identifying Sepsis
Early identification and treatment of sepsis is crucial in preventing patient death.
Sepsis is often misdiagnosed, as it generally comprises non-specific symptoms. The longer sepsis is left untreated, the more severe it becomes and the risk of mortality increases. Therefore, it is crucial to adhere to protocol designed to identify and treat sepsis as soon as possible (D'Orazio Peterson 2013).
Nurses play an essential role in the care of patients with sepsis, with nurse-led initiatives having demonstrated a decrease in mortality, ICU readmission and length of hospital stay (Kleinpell et al. 2019).
Sequential (Sepsis-Related) Organ Failure Assessment (SOFA)
Whenever a patient infection is suspected, the Society of Critical Care Melbourne (2016) recommends undertaking a Sequential (Sepsis-Related) Organ Failure Assessment (SOFA) to assess for organ dysfunction.
This is a simple diagnostic tool comprising three tests. A patient displaying two or more of the following warning signs is at an increased risk of morbidity or mortality and should be assessed for organ failure.
Note: These symptoms must be new to the patient, not pre-existing, in order to be counted.
If a patient presents with two or more of these warning signs, it is also recommended that care is escalated (as appropriate), referral to critical care is considered and the patient is monitored frequently (SCCM 2016).Recognising Sepsis
What to do When Sepsis is Recognised
The Surviving Sepsis Campaign is an international initiative aimed at reducing the global mortality of sepsis. Their ‘Hour-1 Bundle’ guideline sets out five tasks that should be commenced (though may not necessarily be finished) within the first hour of sepsis recognition as part of the initial resuscitation. They are:
- Remeasure lactate if the initial level is elevated (> 2 mmol/L).
- Vasopressors must be administered by a medical practitioner. The administration of this medicine should be considered in a critical care environment, however, if the patient is hypotensive, the objective is to maintain perfusion to all vital organs. Therefore, continuous blood pressure monitoring is imperative. The frequency of observation should be increased.
Sepsis and septic shock are medical emergencies. It is imperative that you act quickly and minimise the amount of time spent before commencing treatment. You must perform a thorough head-to-toe assessment and investigate any obvious signs of infection, increasing the frequency of observations and assessing if the patient is responding to the treatment (e.g. fluid resuscitation). You must inform colleagues about the patient’s status during handovers (SCCM 2019).
You should be able to locate the Surviving Sepsis Campaign’s guidelines at any time, along with your organisation’s own policies and protocols.
The Hour-1 Bundle should be ideally commenced as soon as possible. Sepsis is an emergency and becomes more life-threatening the longer it is left untreated. Immediate intervention after sepsis has been identified is crucial (SCCM 2019; Torborg 2018).
Untreated sepsis can cause the patient’s blood pressure to drop dramatically, causing it to progress into septic shock. The organs are starved of adequate blood supply, resulting in hypoperfusion and leading to multiorgan dysfunction.This is an extremely severe condition that can lead to fatality (Torborg 2018).
In sepsis, hypotension is caused by nitrous oxide production that increases after activation of the endothelium by pro-inflammatory mediators, responsible for vasodilation (Greer 2015).
If the early signs of sepsis have not been identified, the patient can deteriorate rapidly, requiring basic life support. Call for assistance as per hospital protocol. Remember to act quickly to save lives.
50% of people who survive sepsis develop post-sepsis syndrome (Sepsis Alliance 2016). This can be caused by a variety of factors, including any resulting permanent disability from the sepsis and also the psychological effects of both the illness and their prolonged hospitalisation.Symptoms of Post-Sepsis Syndrome
- Nightmares, vivid hallucinations and panic attacks;
- Disabling muscle and joint pains;
- Extreme fatigue;
- Poor concentration;
- Decreased cognitive functioning; and
- Loss of self-esteem and self-belief.
(Sepsis Alliance 2016)
Following recovery from sepsis, healthcare professionals must ensure that the patient’s treatment takes a holistic approach. This is essential as the individual may be feeling not only the physical effects of being ill, but also the psychological and cognitive effects of having sepsis and social isolation following a prolonged hospital stay.
- ACSQHC, Recognising and Responding to Acute Deterioration Standard, https://www.safetyandquality.gov.au/standards/nsqhs-standards/recognising-and-responding-acute-deteriorat ion-standard
- Surviving Sepsis Campaign, Hour-1 Bundle, https://www.sccm.org/getattachment/SurvivingSepsisCampaign/Guidelines/Adult-Patients/Surv iving-Sepsis-Campaign-Hour-1-Bundle.pdf?lang=en-US
- Surviving Sepsis Campaign, COVID-19 Guidelines, https://www.sccm.org/SurvivingSepsisCampaign/Guidelines/COVID-19
- Sepsis Alliance, https://www.sepsis.org/
- Infectious Diseases: How Do You Break the Chain?, https://www.ausmed.com.au/cpd/articles/infectious-diseases
- D'Orazio Peterson 2013, Failure to Diagnose Sepsis, D'Orazio Peterson, viewed 5 May 2020, https://www.doraziopeterson.com/failure-to-diagnose-sepsis
- Greer, JR 2015, ‘Pathophysiology of Cardiovascular Dysfunction in Sepsis’, BJA Education, vol. 15 no. 6, viewed 7 May 2020, https://academic.oup.com/bjaed/article/15/6/316/356327
- Kleinpell, R, Blot, S, Boulanger, C, Fulbrook, P & Blackwood, B 2019, ‘International Critical Care Nursing Considerations and Quality Indicators for the 2017 Surviving Sepsis Campaign Guidelines’, Intensive Care Medicine, viewed 5 May 2020, https://link.springer.com/article/10.1007/s00134-019-05780-1
- NIH 2019, Sepsis Fact Sheet, NIH, viewed 5 May 2020, https://www.nigms.nih.gov/education/Documents/Sepsis.pdf
- Nursing Times 2014, Early Identification and Treatment of Sepsis, Nursing Times, viewed 5 May 2020, https://www.nursingtimes.net/clinical-archive/infection-control/early-identification-and-treatment-of-seps is-17-01-2014/
- Sepsis Alliance 2016, Post-sepsis Syndrome, Sepsis Alliance, viewed 6 May 2020, https://www.sepsis.org/sepsis-basics/post-sepsis-syndrome/
- Sepsis Alliance 2018, Symptoms, Sepsis Alliance, viewed 6 May 2020, https://www.sepsis.org/sepsis-basics/symptoms/
- Sepsis Alliance 2017, What is Sepsis, Sepsis Alliance, viewed 5 May 2020, https://www.sepsis.org/sepsis-basics/what-is-sepsis/
- Society of Critical Care Medicine 2016, Sepsis Definitions, Society of Critical Care Melbourne, viewed 5 May 2020, https://www.sccm.org/Research/Quality/Sepsis-Definitions
- Society of Critical Care Medicine 2019, Hour-1 Bundle: Initial Resuscitation for Sepsis and Septic Shock, Society of Critical Care Melbourne, viewed 5 May 2020, https://www.sccm.org/getattachment/SurvivingSepsisCampaign/Guidelines/Adult-Patients/Surviving-Sepsis-Campaign-Hour-1-Bundle.pdf?la ng=en-US
- Torborg, L 2018, Mayo Clinic Q and A: Understanding Sepsis and Septic Shock, Mayo Clinic, viewed 5 May 2020, https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-understanding-sepsis-and-septic-s hock/
- World Health Organisation 2018, Sepsis, World Health Organisation, viewed 5 May 2020, https://www.who.int/news-room/fact-sheets/detail/sepsis
(Answers: a, b, a)
Ausmed Editorial Team
Ausmed’s Editorial team is committed to providing high-quality and thoroughly researched content to our readers, free of any commercial bias or conflict of interest. All articles are developed in consultation with healthcare professionals and peer reviewed where necessary, undergoing a yearly review to ensure all healthcare information is kept up to date. See Educator Profile
Sally Moyle is a rehabilitation nurse educator who has completed her masters of nursing (clinical nursing and teaching). She is passionate about education in nursing so that we can become the best nurses possible. Sally has experience in many nursing sectors including rehabilitation, medical, orthopaedic, neurosurgical, day surgery, emergency, aged care, and general surgery. See Educator Profile