severe sepsis
What are the four elements of SIRS?
HR >90, RR>20, WBC >12 or <4, Temp <38.3 or < 36
What is the time frame when the first lactate should be drawn?
Within 3 hours of severe sepsis time zero.
How do you define "intial hypotension" ?
Hypotension (SBP,90 MAP<65) that is 6 hours before or 6 hours after severe sepsis time zero and within 3 hours each other.
What are the elements in the 3 hour bundle?
Lactate
Blood culture
Antibiotics
It is completed before we sign out to oncoming or accepting RN.
What is the "purple form"?
Name 5 elements that meet for organ dysfunction
SBP <90, MAP<65
Cr >2
Bili >2
Plt <100
LA >2
INR >1.5
When do you repeat the lactate level?
When the initial lactate is >2
How much fluid should be administered for initial hypotension or septic shock?
30ml/kg
When is the best time to administer antibiotic?
After drawing the blood culture
When do you complete the purple form?
Begin any time a suspected infection is recognized and through completion of 3 and 6 hour bundle elements for patients with sepsis.
How does CMS define severe sepsis?
Suspected source of infection AND 2SIRS and Organ Dysfunction within 6 hour of each other.
When is the best time to collect blood cultures?
Prior to the start of IV antibiotic administration
What is the nurse's role in determining if vasopressors are required?
Documentation of blood pressures within the hour after the targeted fluid administration (continue to take blood pressures every 15 minutes throughout fluid administration and through at least 1 hour after completion.
What are the elements of the 6 hour bundle?
Crystalloid fluids
Vasopressor
Perfusion exam
What information do you share at handoff for sepsis ?
When is time zero?
Shock time zero is when hypotension occurs after fluid is administered and after severe sepsis time zero
When is fluid required to be given to a patient with lactate >4?
Within 3 hours of septic shock time zero.
HR 95 at 0800
RR 22 at 0815
B/P 85/40 at 1430
Labs - lactate 1.5 at 0900, Cr 2.2 @ 1200
Is this severe sepsis?
Yes severe sepsis at 1200