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SURVIVING SEPSIS

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by

Edward Hardy

on 3 September 2013

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Transcript of SURVIVING SEPSIS

SURVIVE SEPSIS
SEPSIS
37,000 deaths / year in UK
~40% mortality in severe sepsis
> 50% mortality in septic shock
Definitions
SEPSIS:
The presence (probable or confirmed) of

infection
with
systemic inflammatory response

SEVERE SEPSIS:
Sepsis + sepsis induced

organ dysfunction
or
tissue hypoperfusion
Pathophysiology
Managing Sepsis
ABCDE approach
What Next?
Systemic Inflammatory
Response Syndrome (SIRS)
Evidence of Infection
SIRS
- HR > 90bpm
- RR > 20bpm
- Temp >38/<36
- WCC <4/>12
- Acutely Altered
Mental State
- CBG >7.7
Evidence of Infection
Fevers, rigors, malaise
Abdominal - pain, D&/V, distended, etc
Urine - dysuria, freq, catheter, urine dip
Respiratory - cough, sputum, chest pain
CNS - headache, photophobia, neck stiffness
Cellulitis, Septic Arthritis, Wound infectio
Line infection - any lines in >48 hours
Gynae - discharge, pain, IUD
Endocarditis - murmur
Evidence of Organ Dysfunction or Tissue Hypoperfusion
- Lactate > 4
- Sepsis induced hypotension
(systolic<90, mean<65)
- Urine output <0.5ml/kg/hr
(for 2hrs despite adequate
hydration)

Lung - O2 Sats <90%
Kidney - Creat >177
Liver - Bilirubin > 35
Haem - plt < 100
Clotting - INR > 1.5
Bowel - ileus (no bowel sounds)
Within 1 hour:
1) High Flow O2 [via non rebreathe mask]
(A&B)
2) IV Fluid bolus [500-1000ml Crystalloid]
(C)
3) Monitor Hourly Urine Output [+/- Catheter]
(C)
4) Check Lactate Level
(C)
5) Send Cultures
(Diagnosis)
6) IV ANTIBIOTICS
(ABCDE)
- Lactate > 4
- Sepsis induced hypotension
(systolic<90, mean<65)
- Urine output <0.5ml/kg/hr
(for 2hrs despite adequate
hydration)
- Lung - O2 Sats <90%
- Kidney - Creat >177
- Liver - Bilirubin > 35
- Haem - plt < 100
- Clotting - INR > 1.5
- Bowel - ileus (no bowel sounds)
ABC again
Monitor
Investigations for definitive diagnosis

Involve Seniors:
SPR / Consultant
Refer to specialty if needed
ITU / Critical Care Outreach
Further Reading:

ABC of Sepsis (in library)

Russel JA et al. Management of Sepsis. 2006.
NEJM 355(16) 1699-1713
References:
Daniels R etl al. The sepsis six and the severe sepsis resuscuitation bundle: a prospective observational cohort study. Emerg Med J. 2011;28: 507-512

Dellinger RP et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012. CriticalCareMedicine J. 2013;41(2): 580-637
Full transcript