Rescuscitation in Sepsis

Question 1

Infection

Answer 1

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

Question 2

What is sepsis?

Answer 2

Evidence of infection plus organ dysfunction - life threatening organ dysfunction

serious complication in infection associated with high mortality

Question 3

Cause of SEPSIS

Answer 3

Overwhelming host response to the microbes

Question 4

How do we identify SEPSIS?

Answer 4

NEWS >5 + Evidence of infection

Question 5

How do we treat SEPSIS?

Answer 5

Take 3:

1. Blood cultures
2. Lactate
3. Measure Urine output

Give 3:

1. Oxygen
2. IV Antibitoics
3. IV Fludis

Question 6

What is the mortality associated with Septic shock?

Answer 6

40%

Question 7

What are the criteria for Spetic shock?

Answer 7

Hypotension despite Fluid resuscitation with 30ml/ kg fluid and vasopressers

lactate >2

Question 8

O2 administration features

Answer 8

Titrate O2 level to 94-98%

Question 9

When should O2 be given to a patient?

Answer 9

If their blood O2 sats <94%

Question 10

What do you consider in someone with acidosis?

Answer 10

Give O2 accordingly, more unwell if worsening acidosis, lactate acidosis

Question 11

IV Antibiotics

Answer 11

ASAP
within the 1st hour

Localise the infection and prescribe appropriately

Question 12

IV Fluids

Answer 12

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

Question 13

What is a fluid challenge?

Answer 13

Set volume of IV Fluid over a set time

Question 14

Dextrose vs crystalloid

Answer 14

Cystalloid doesnt stay in intravascular space

Dextrose - varies a lot

Question 15

Why do people get septic?

Answer 15

Vasodilated

Question 16

Lactate

Answer 16

Measure lactate (and other bloods)
High lactate, sign of hypoperfusion (low BP) in sepsis
Lactate >4 - it should be repeated every 4-6 hours

Question 17

What is a sign of hypoperfusion?

Answer 17

Lactate

Question 18

Meaure urine output

Answer 18

Marker of organ perfusion

fluid balance should be commenced on admission

0.5 ml/ kg / hour

Question 19

Importance of hours 2-6

Answer 19

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

Question 20

What is the aim of treatment in 2 - 6 hours?

Answer 20

• improvement in NEWS
• improve haemidynamic instability
• reduce lactate

Question 21

Concerning signs of deteriorating patient with NEWS

Answer 21

New confusion - poorp erfusion of brain
High RR
Low BP
Low BM
Low blood sugar

Question 22

What is the surrogate for metabolic acidosis?

Answer 22

High RR

Question 23

What is the mortality rate associated with a qSOFA score >2?

Answer 23

40%

Question 24

What is the ongoing mangaement for those not responding?

Answer 24

Escalate to MDHU

make a desicion - ceiling of treatment

Question 25

What should be done in patients not responding whose MAP remains <65 mm Hg?

Answer 25

then add vasopressors (Noradrenaline) via CVC

Question 26

What is the main vasopressor used in SEPSIS?

Answer 26

Noradrenaline

Ensure source control
Consider the addition of steroid - only in severe cases
Refer to the ICU for addition of additional vasopressin

Question 27

Symtpoms of SEPSIS

Answer 27

• Very high or low temperature
• Uncontrolled shovering
• Confusion
• Cold or blotchy hands and feet
• Not passing as much urine as normal

Question 28

Are sterids usually given in SEPSIS?

Answer 28

No

Only in serious cases