Sepsis
What is Sepsis?
The body's extreme response to an infection injuring it's own tissue & organs. Can lead to shock, multiorgan failure, & death
What are the three common fallouts occurring in HMC ED related to sepsis care?
Not repeating the lactate, not administering abx in time, not documenting the reassessment of persistent hypotension
When does time zero start?
When there is 2 or more SIRS criteria met and confirmed or suspected infection
What is the #1 cause of deaths in hospitals?
Sepsis! Sepsis kills every 2 mins in the USA. Annually, 1.7 million adults in the USA develop sepsis and 350K die.
50% of sepsis survivors suffer from long term physical and/or psychological effects
80% of sepsis cases occur outside of a hospital
When should broad spectrum antibiotics be administered for the sepsis bundle?
After BC X 2 drawn. Goal administration within 1st hour. Max within 3 hour of time zero. Ask for IM order if IV access cannot be established.
V.S.: 38.4'C, 120, 28, 90/54, 90% RA
What will you document?
In V.S. note document an intervention and/or provider notified
What is the #1 cause for hospital readmission?
Sepsis. Costs > 3.5 Billion/yr.
How should you document the reassessment of interventions/persistent hypotension in caring for a pt with sepsis?
Document a minimum of two BP within the hour after each fluid bolus and abx administered (cycle q 15 min.) or vasopressor (cycle q5min.)
Goal MAP when treating sepsis?
Greater than/equal to 65
What is the #1 cause for healthcare costs?
Sepsis. 62 Billion/yr.
When does a Lactate need repeating per the sepsis bundle?
Within six hours of time zero if initial lactate is >2.0
Pt has received two 30ml/kg NS boluses. Remains altered, cool-dry-mottled, cap refill >5 seconds, no urine output, with +1 pulses. ST 130s, 28, 70/50 map 57. What is your actions/documentations?
Document a minimum of two BP within an hour of boluses for reassessment, document provider notified, recommend/plan for vasopressors, cycle V.S q5mins, titrate per order