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Transcript
The second T is for
Tachycardia, heart rate > 90 bpm
Management
Priorities:
1. Correct Physiologic Abnormalities like hypoxemia or hypovolemia
2. Identifying and Treating the infection
Management and Therapy
Preexisting illness:
Death is significantly during the third to fifth decades.
No preexisting morbidity:
- Fatality rate remains <10% until the fourth decade of life
- It gradually increases to exceed 35% in the very elderly
Though in hospital mortality decreased between 1979 and 2001...
Mortality rates remain at about 15-20%
Estimates of the risk of dying of severe sepsis:
- Patient's age
- Underlying condition
- Various physiologic variables
Prognosis:
APACHE II Stratification
Prognosis
Diagnosis
Diagnosis of sepsis lies on identification of the 4 cardinal signs of Severe Inflammatory Response Syndrome and suspected infection
The SIRS Criteria: 3T's and the 1W, Just Need 2
30 Day Mortality of Patient by Septic Subtype
- Severe Sepsis: 20-35%
- Septic Shock: 40-60%
Diagnosis
A respiratory rate >20 breaths/minute
The third T is for Tachypnea
Fever of temperature >38°C
OR
Hypothermia (<36°C)
The first T is for Temperature
Diagnosis: SIRS/Sepsis Criteria
3T's, 1W, Just Need 2
Prognosis
The key point is that sepsis is a fatal disease and it is our job as physicians and healthcare providers to be ever vigilant in this fatal illness
Central Venous Catheters
Central venous catheters can be used for:
infusing medications, blood products, and fluids
drawing blood
central venous pressure and central venous oxygenation monitoring
Respiratory Stabilization
Supplemental Oxygen and Pulse oximetry
Consider intubation and mechanical ventilation
F/U respiratory interventions with ABG and CXR
Sepsis
Assess for hypotension using blood pressure
Check for other signs of hypoperfusion such as skin temperature abnormality, altered mentation, restlessness, oliguria/anuria, or lactic acidosis
Aspects of hypoperfusion may be patient specific
Perfusion Status
The W stands for White Blood Cell Count
Leukocytosis >12,000/uL
or
Leukopenia <4,000/uL
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