Analysing the ongoing priorities of treatment and care

Regardless of how severly ill the patient is, where sepsis is suspected, the priorities of treatment and care need to remain those of:

• Blood tests: Assessing these reguarly and responding to changes.
• Serum lactate: Assessing the lactate level together with a blood gas as necessary.
• Infection screen and early intravenous antibiotics: Reviewing the ongoing need for infection screening. Staying SMART and changing antibiotics to more targeted antibiotics once the causative organism is known. Regular reviews of antimicrobial treatment given.
• Intravenous fluids: Ongoing assessment and response to the patient's level of hydration. Patients with sepsis easily become dehydrated as fluid moves out of the blood stream into the interstital space as the infections cause capillaries to become leaky. Dehydration often leads to one of the initial signs - a reduced urine output for the patient.
• Ongoing monitoring: It is vital to monitor the respiratory and cardiovascular stability of the patient. As haemoglobin is affected in sepsis, the oxygen carrying capacity of the red blood cells falls. Consequently, respiratory and heart rates rise. The BP will fall usually in response to the drop in blood circulating volume. Lowered oxygen levels will require oxygen therapy to be titrated to maintain SaO₂ 94-98% or 88-92% in known COPD.
• Escalation of care: If the risk of sepsis is increasing, more invasive monitoring and cardiovascular support using inotropes and vasopressors may be required. Early escalation to appropriately experienced healthcare professionals (e.g. Registrar, consultant, or Critical Care team) is essential.