RLO: Exploring the Sepsis Care Bundle

This assessment is correct

is at moderate (amber) risk of death from sepsis.

There are signs of infection in that her temperature is high. Consequently her heart rate and respiratory rate are also high and her blood pressure is lowered. Oxygen saturations are 94%. She has no sepsis criteria within the high (red) risk category but does have criteria within the moderate (amber) risk category.

A number of investigations were undertaken in ED and treatment was started.

A fluid bolus has been given in response to the perceived dehydration.

Antibiotics were prescribed and given in response to the assumed infection once blood cultures were taken. This is borne out by the high c-reactive protein result.

MEDICINE PRESCRIPTION AND ADMINISTRATION RECORD
WARD Emergency Dept. WARD __________ WARD __________			CONSULTANT ____________________		DATE OF ADMISSION		NAME: AGE: HOSPITAL NUMBER: NHS NUMBER:
Card No 1 of 1		Chart rewritten By _____________ Date ________________________ Pharmacy check By _____________ Date ________________________			Weight _______(kg) Date ____________ Weight _______(kg) Date		NAME: AGE: HOSPITAL NUMBER: NHS NUMBER:
DRUG ALLERGY or ADVERSE EFFECT Medicine/Other Signature				If none know tick box [✔] Effect Date This section must be completed and signed by a prescriber or Pharmacist
ONCE ONLY MEDICINES
Date	Medicine	Dose	Route	Administration Instructions	Time Required	Prescriber's Sig, Print Name & Bleep	Time Given	Given By	Checked By	Pharm
	Tazocin	4.5g	I.V.	Give Immediately	18.00	A.BRN 1234	18.15	JE	AM
	Salbutamol	2.5mg	neb		18.00	A.BRN 1234	18.15	JE	AM
	Atrovent	500mg	neb		18.00	A.BRN 1234	18.15	JE	AM

Patient Details Patient Name: Age: Hospital Number:				FLUID CHART DATE: WARD: Emergency Dept.
INPUT (mLs)						OUTPUT (mLs)
Time	Intravenous fluid	Other (write)	DRUG (write) Noradrenaline	Hourly total	Running total	Urine	Hourly total	Running total	Balance (+ve or -ve)
01:00
...
18:00	500					++ incontinent
19:00	500	30 (tazocin)		1030	1030				+ve 1030
20:00	500, 500			1000	2030				+ve 2030
21:00
22:00
23:00
24:00

Patient Details Patient Name: Age: Hospital Number:				FLUID CHART Part One \| Part Two DATE: WARD: Emergency Dept. PREVIOUS DAY'S BALANCE: +ve 2533
INPUT (mLs)						OUTPUT (mLs)
Time	Intravenous fluid	Other (write)	DRUG (write) Noradrenaline	Hourly total	Running total	Urine	Hourly total	Running total	Balance (+ve or -ve)
01:00	250		10	260	260	30	30	30	+ve 230
02:00	250		10	260	520	35	35	65	+ve 455
03:00	250		10	260	780	40	40	105	+ve 675
04:00	250		10	260	1040	15	15	120	+ve 920
05:00	250	500 Hartman's	10	760	1800	25	25	145	+ve 1655
06:00	250		10	260	2060	30	30	175	+ve 1885
07:00	250		10	260	2320	30	30	205	+ve 2115
08:00	250		10	260	2580	20	20	225	+ve 2355
09:00	250		10	260	2840	10	10	235	+ve 2605
...

Haematology and CoagulopathyClinical Chemistry and Liver Function Tests
Test	Normal Values	18:30	20:15	06:00
HB	11.5 - 16.5 g/dL	10.0
Platelets	150 - 450 x 10^-9/L	120
WBC	4.0 - 11.0 x 10^-9/L	14.0
MCV	84 - 102 fL	85
Neutrophils	2.0 - 7.5 x 10^-9/L	9.0
ESR	1 - 20
APTT Ratio	0.85 - 1.14
INR	0.8 - 1.2
Prothrombin Time	10.0 - 12.0 sec's	12
APTT	21.0 - 29.0 sec's	32
Thrombin Time	17.0 - 21.0 sec's	21
D-Dimer	0 - 250 µg/L	200
Fibrinogen	1.8 - 4.0 g/L

Clinical Chemistry and Liver Function TestsHaematology and Coagulopathy
Test	Normal Values	18:30	20:15	06:00
Sodium	134 - 145 mmol/L	140
Potassium	3.5 - 5.3 mmol/L	4.5
Urea	2.9 - 7.5 mmol/L	10.0
Creatinine	45 - 84 µmol/L	100
GFR	(ml/min)
Glucose	4.0 - 8.0 mmol/L	9.9
Amylase	0 - 110 U/L
CK	25 - 200 U/L
ALT	0 - 35 U/L	30
γGT	0 - 40 U/L	50
Bilirubin	0 - 21 µmol/L	40
Alk Phosphate	40 - 130 U/L	180
Albumin	30 - 50 g/L	24
CRP	0 - 10 mg/dL	110
Troponin	up to 0.1 µg/L
Bicarbonate	24 - 32 mmol/L
Calcium	2.2 - 2.6 mmol/L
Phosphate	0.8 - 1.45 mmol/L
Magnesium	0.7 - 1.0 mmol/L

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Assessing the risk of death from sepsis

High (Red) Risk Criteria:

Moderate (Amber) Risk Criteria:

Low (Green) Risk Criteria: