Sepsis Bundle
Known or suspected infection plus what 2 qualifiers trigger a positive sepsis screen?
Temp <96.8 or >100.9
HR > 90
RR > 20
WBC <4k or >12k
What MUST be completed (ended, infused) in the EMAR?
IV fluids and antibiotics
What are the most common early vital sign changes in sepsis?
tachycardia, or tachypnea
What type of antibiotic should be given initially for suspected sepsis?
Broad spectrum
What is the difference between sepsis and septic shock?
Septic shock includes persistent hypotension (hypotension despite fluid bolus) requiring vasopressors and lactate >2.
2 diagnostic blood tests needed
What must be documented regarding blood cultures?
Reason for delay in collection
What does a lactate level >2 signify in the context of sepsis?
tissue hypoperfusion
What is the first line vasopressor recommended for septic shock?
Norepinephrine
Approximately what percentage of hospital deaths are associated with sepsis?
30-35%
What is the timeframe for completing the initial bundle once sepsis is suspected?
ONE HOUR
A septic patient has been started on vasopressors, what should you remind the provider to do?
A sepsis reassessment
Which skin changes may be seen in a patient with worsening sepsis?
Cool, mottled, or clammy skin
Why is source control (removing infected lines, draining abscesses, etc.) critical in treating sepsis?
Eliminate the source of infection
Name 2 common sources of infection that lead to sepsis.
Lung (pneumonia), urinary tract, abdominal, bloodstream
What is the treatment for hypotension OR lactic acid >4?
30ml/kg bolus (NS or LR) at a rate >125
Why is it important to document the first time sepsis was suspected?
To establish bundle compliance and measure time to treatment
True or False
Fever is always present in sepsis
False
<96.8 OR >100.9
How often should the lactate be remeasured if >2
2 hours
Why is sepsis described as a medical emergency?
Rapid progression can lead to shock, organ failure, and death if untreated.
When should a vasopressor be started?
When the patient remains hypotensive after a fluid bolus (maintain MAP >65)
Why are nurse driven sepsis programs successful?
Nursing knows what and when things need to be done- Remind the provider to document WHY it's not sepsis, WHY they ordered a lesser amount of fluids.
Name 2 mental status changes that may indicate sepsis
Confusion, lethargy, agitation
Why is early recognition and treatment of sepsis considered time critical?
Each hour of delay increases mortality
What is the definition of sepsis?
A Life-threatening organ dysfunction caused by a dysregulated host response to infection.