Neutropenic Sepsis Scenario (ECA)

Question 1 of 10

1. Question

What is the patient’s NEWS score?

8

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9

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6

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11

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Question 2 of 10

2. Question

You start to take the blankets off the patient as you think her temperature may be causing the rigors she is experiencing. She is not happy about it, but you reassure that it is the best for her treatment. You are querying sepsis.

What oxygen therapy should be applied?

If SpO₂ seems accurate, it is not required if saturations are 96%

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High flow oxygen required due to critical illness

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Nasal cannula to ease dyspnoea

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Question 3 of 10

3. Question

The patient is also complaining of abdominal pain, which seems to relieve slightly after a vomiting episode. Her last bout of diarrhoea and vomiting was one hour ago. There was no melaena reported.

Your colleague tries to cannulate to provide pain relief, anti-emetics, and fluid therapy, but is unable to gain IV access. The patient states she usually requires ultrasound guidance in hospital to obtain access. While your colleague looks at further options you question about their past medical history.

The patient has a history of:

Breast cancer with mastectomy

Secondary liver cancer (currently receiving treatment)

Diverticulitis

Hypertension

Type 2 diabetes

Hypothyroidism

She states she has had this pain and symptoms before but has never felt this unwell in the past. What would be your primary differential diagnosis?

Sepsis secondary to diverticulitis

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Diverticulitis

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Gastroenteritis

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Food poisoning

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Question 4 of 10

4. Question

You query sepsis secondary to diverticulitis, similar to previous episodes. With this diagnosis, and based on what you have learned about your patient so far, what would be an immediate red flag highlighting the need for prompt management?

Current treatment for liver CA

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Type 2 diabetic and slightly high blood sugars

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Diarrhoea associated with diverticulitis

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Minimal fluid intake for the last 6 hours

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Question 5 of 10

5. Question

You are concerned that the patient is currently receiving treatment for liver cancer, which may point to neutropenic sepsis. What cancer treatment methods can be associated with neutropenia?

Chemotherapy

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Radiotherapy

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Immunotherapy

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Question 6 of 10

6. Question

Why should patients receiving certain cancer treatments and those at risk of neutropenia be considered carefully when managing possible infections?

Neutropenia means the patient has a lower blood count of neutrophils, an important white blood cell that fights bacterial infections, and therefore a patient may deteriorate quickly during infection due to a reduced immune response

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Neutropenia means the patient has a lower total white blood cell count, which is important to fight infections, therefore a patient may deteriorate quickly during infection due to a reduced immune response

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Neutropenia means the patient has a higher white blood cell count, and therefore a patient may deteriorate quickly during infection due to a heightened immune response which may exacerbate autoimmune features of sepsis causing multi-organ failure

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Neutropenia means the patient has a reduced number of platelets which is associated with significantly increased risk of bleeding and thin blood which when accompanied with sepsis can exacerbate distributive shock

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Question 7 of 10

7. Question

Your colleague has given IM Ondansetron and now tries oral paracetamol to help with the pain as she has not vomited for some time and is currently not feeling nauseated. What would be the appropriate transfer for this patient?

ASHICE to local ED

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Routine transport to local ED

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Referral to nearest medical assessment unit

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Referral to nearest surgical assessment unit

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Question 8 of 10

8. Question

It is a cold night and as you move the patient to the ambulance, her temperature begins to drop. Her new observations on entering the ambulance are:
HR 105, BP 98/63, RR 24, SpO₂ 96%, Temp 38.5

Her NEWS score has reduced to 6. Would this change your decision to ASHICE this patient?

No

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Yes

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Question 9 of 10

9. Question

Any fever of 37.5°C or above in a patient with a history of cancer treatment should be considered neutropenic sepsis.

True, any fever should trigger neutropenic sepsis risk until blood tests can prove otherwise

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False, usual NEWS scores should be applied first to determine sepsis

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Question 10 of 10

10. Question

Some medications including Corticosteroids (e.g. Prednisolone, Hydrocortisone, Dexamethasone) could mask elevated temperatures.

True

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False

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Neutropenic Sepsis Scenario (ECA)

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