SIRS, Sepsis, Septic Shock
Name 2 SIRS Criteria
Temperature >38*C or <36*C
HR > 90
RR > 20
WBC >12,000 or <4,000, or 10% Bands
When can a blood culture be drawn off of an IV line?
Upon initial insertion or if it has been in place for less than 1 hour and had been prepped with CHG.
How long do you have to start antibiotics on a patient with sepsis?
60 Minutes
When is an IVF Bolus of 30mL/kg initiated?
When initial lactic is >4 or if the patient's SBP is <90 or MAP <65
Bright Green!
What is Sepsis?
A life-threatening organ dysfunction caused by a dysregulated host response to infection
How many mLs of blood do you need to have in a blood culture bottle for an adult?
8-10mL
Your patient came in at 1400 with vital signs WNL. At 1530 you note that your patient's HR is 112 and temperature is 101.2 Oral. They are being worked up for pneumonia. At what time would your antibiotics be due by?
1630. Your timer started at 1530.
After a IVF Bolus is complete, what documentation needs to be included?
Chart BP X 2 within 1 hour
Document infusion complete in MAR
When does your Sepsis Timer begin?
Upon recognition of Sepsis: 2 SIRS Criteria + Source of Infection
Provider documentation of "Severe Sepsis" or "Septic Shock"
Your patient reports SOA. Which of the following Vital Signs are positive for SIRS Criteria?
HR 89, RR 24, T. 100.9, SpO2 85%, BP 110/70
RR 24, T 100.9
If your patient has a lactic of 2.0, do you have to draw a two hour repeat?
No. 2.0 does not require a repeat, anything GREATER than 2.0 you will need a repeat.
What should be drawn and documented prior to administering antibiotics?
Blood Cultures
What are the two vasopressors that are included in the sepsis treatment orderset?
Leveophed (norepinephrine)
Vasopressin
What is the best way to prevent sepsis protocol misses when transferring care?
Hand-off communication
Using the Green Sepsis Sheet
What is the difference between Sepsis and Severe Sepsis?
Sepsis is SIRS + Infection
Severe Sepsis is Sepsis + End organ damage
How long do you have to draw labs, including a lactate and blood cultures?
45 Minutes
According to the Sepsis Checklist, what type of antibiotic should be given first?
Broad Spectrum
Your patient is hypotensive and septic. How much time do you have from sepsis recognition to when the IVF bolus should be started?
60 Minutes
What needs to be documented at least every hour for a Septic Patient in the ED?
A full set of vitals including: Temperature, HR, RR, BP (with MAP)
Name 3 Sepsis Look-alike that may delay identification of sepsis.
Drug OD, trauma, burns, ETOH withdrawal, acute pancreatitis, PE, anaphylaxis, adrenal insufficiency, neurogenic shock, thyrotoxicosis
What negative impact does a contaminated blood culture have on a patient?
Unnecessary antibiotics & cost
If you are having issues obtaining your antibiotic and it is not given within 60 minutes, what should you do?
Alert your leadership on shift and make a note in the patient's chart as to why there was a delay.
Your patient's body weight is 478lbs but an IVF bolus of 2,000mL was ordered. Where did the 2,000mL come from?
Ideal body weight calculation
What should be documented by the provider if the full 30mL/kg IVF is not given?
A reason must be noted by the provider if the patient does not receive the entire IVF bolus. Such as, "concern for fluid overload."