Sepsis Basics
Systemic inflammatory response to presumed or proven infection
What is Sepsis?
Initiation Bundle upon recognition of sepsis/septic shock
What is 1-hour bundle?
the clinical syndrome that results from a deregulated inflammatory response or to a noninfectious insult
What is Systemic inflammatory response syndrome (SIRS)?
Repeat _______ if initial level > 2mmol/L
What is Lactate?
First line for initial resuscitation
What are Crystalloids? Consider albumin if large volume of crystalloids are required
The patient must have two (2) or more of these criteria to trigger Sepsis
What is (Must answer with at least 2)
Temperature >38o C or <36o C OR
Heart Rate >90 bpm OR
RR > 20 bpm OR
WBC count > 12,000/mm3 or <4,000/mm3 or >10% immature neutrophils
The FIRST step on the bundle
What is measure lactate level?
*Remeasure lactate if initial lactate elevated (>2mmol/L)
SIRS that is secondary to infection that has been diagnosed clinically. Positive cultures add to the validity but are not required for the diagnosis
What is SEPSIS?
Initiated after fluid resuscitation if SBP <90 or MAP < 65mm Hg
What is Vasopressor?
* more Specifically Levophed
First line Vasopressor
What is Norepinephrine/Levophed?
Clinical Signs of organ dysfunction for Neuro and Heme
what is Altered LOC, hypo/hyperthermia and Platelet count <100,000 microliter, INR>1.5
SECOND STEP
What is blood cultures?
*Must be drawn prior to administering antibiotics
Sepsis plus at least one sign of hypoperfusion or organ dysfunction, that is new, and not explained by other known etiology of organ dysfunction
What is Severe Sepsis?
What is a Cordis?
Additional agent needed to Maintain MAP
What is Epinephrine?
Clinical signs of organ dysfunction for Pulmonary and GI
What is Hypoxemia, ARDS and Hyperbilirubinemia > 2mg/dL
THIRD step
what is administer broad-spectrum antibiotics?
Severe sepsis associated with refractory hypotension (BP<90/60) despite adequate fluid resuscitation and/or a serum lactate level >=4.0 mmol/L
What is Septic Shock?
VS, Cardio Pulmonary Exam, Peripheral pulse evaluation, capillary refill evaluation, and skin exam
What is a focused exam?
________ can be used in combination with Norepinephrine if unable to maintain MAP
What is Vasopressin?
Clinical signs of organ dysfunction for Cardiac and Renal
What is hypotension and AKI (Cr> 2mg/dL)?
Fourth Step
* Rapid Administration is 30 mL/kg
initial time of recognition of severe sepsis (SIRS and organ dysfunction). Rely on a time at which signs, symptoms, and laboratory findings are first consistent with the above definitions of severe sepsis/septic shock.
What is Presentation time?
returns a reservoir of venous blood into the central circulation relatively quickly (30-90 seconds). It's the original, all-natural fluid bolus
What is Passive Leg Raise?
Consider ________ in select patients with marked LV dysfunction
What is Dopamine?
Severe sepsis with hypotension that does not resolve with adequate volume resuscitation
What is Septic Shock?
Fifth Step
What is apply vasopressors if hypotensive during or after fluid resuscitation to maintain a mean arterial pressure >/= 65 mm Hg
What is Surviving Sepsis Campaign?
The date/time on which the last criterion was met to establish the presence of severe sepsis or septic shock
What is Time Zero?
Remove a potentially infected device, drain any abscess, debride infected necrotic tissue as soon as possible
What is Source Control?