Rescuscitation in Sepsis Flashcards
Infection
Invasion and multiplication of micro-organisms within the body
- maybe localised (abscess)
- maybe disseminated (eg: bacteraemia)
Some organisms live locally in the areas and are not considered infection
What is sepsis?
Evidence of infection plus organ dysfunction - life threatening organ dysfunction
serious complication in infection associated with high mortality
Cause of SEPSIS
Overwhelming host response to the microbes
How do we identify SEPSIS?
NEWS >5 + Evidence of infection
How do we treat SEPSIS?
Take 3:
- Blood cultures
- Lactate
- Measure Urine output
Give 3:
- Oxygen
- IV Antibitoics
- IV Fludis
What is the mortality associated with Septic shock?
40%
What are the criteria for Spetic shock?
Hypotension despite Fluid resuscitation with 30ml/ kg fluid and vasopressers
lactate >2
O2 administration features
Titrate O2 level to 94-98%
When should O2 be given to a patient?
If their blood O2 sats <94%
What do you consider in someone with acidosis?
Give O2 accordingly, more unwell if worsening acidosis, lactate acidosis
IV Antibiotics
ASAP
within the 1st hour
Localise the infection and prescribe appropriately
IV Fluids
Fluid challenge - set volume over set time
Set over 250-500 mls over 15 mins (crystalloid - 0.9% Saline of hartmanns)
Aim for
- MAP >65 mmHg
- 30ml/kg over the 1st 3 hours
If lack of response in BP then consider early transfer to MDHU for CVC +/= vasopressors
What is a fluid challenge?
Set volume of IV Fluid over a set time
Dextrose vs crystalloid
Cystalloid doesnt stay in intravascular space
Dextrose - varies a lot
Why do people get septic?
Vasodilated
Lactate
Measure lactate (and other bloods)
High lactate, sign of hypoperfusion (low BP) in sepsis
Lactate >4 - it should be repeated every 4-6 hours
What is a sign of hypoperfusion?
Lactate
Meaure urine output
Marker of organ perfusion
fluid balance should be commenced on admission
0.5 ml/ kg / hour
Importance of hours 2-6
Continue resuscitiation
- aim 30.l/kg in first 3 hours
- MAL >65
- urine output > 0.5 ml/kg/hour
Aim - imporvement in NEWS
- improve haemidynamic instability
- reduce lactate
What is the aim of treatment in 2 - 6 hours?
- improvement in NEWS
- improve haemidynamic instability
- reduce lactate
Concerning signs of deteriorating patient with NEWS
New confusion - poorp erfusion of brain High RR Low BP Low BM Low blood sugar
What is the surrogate for metabolic acidosis?
High RR
What is the mortality rate associated with a qSOFA score >2?
40%
What is the ongoing mangaement for those not responding?
Escalate to MDHU
make a desicion - ceiling of treatment
What should be done in patients not responding whose MAP remains <65 mm Hg?
then add vasopressors (Noradrenaline) via CVC
What is the main vasopressor used in SEPSIS?
Noradrenaline
Ensure source control
Consider the addition of steroid - only in severe cases
Refer to the ICU for addition of additional vasopressin
Symtpoms of SEPSIS
- Very high or low temperature
- Uncontrolled shovering
- Confusion
- Cold or blotchy hands and feet
- Not passing as much urine as normal
Are sterids usually given in SEPSIS?
No
Only in serious cases
