Resus in sepsis Flashcards
Sepsis definition
evidence of infection PLUS evidence of organ dysfunction
How to identify sepsis
NEWS >5 AND evidence of infection
Septic shock
Hypotension despite fluid resuscitation (30ml/kg) and vasopressors and a lactate >2
Mortality of sepsis
10%
Mortality of septic shock
40%
Risk factors for sepsis (4)
very young <1y, old >70yrs, immunosuppressed - chemo, steroids, biological therapies, recent surgery, drug misuse, splenectomy, pregnancy, neonates
Sepsis 6 should be done within how long after recognition of sepsis?
1 hour
Sepsis 6? Take 3 give 3
Take blood cultures, take lactate levels, take urine output, give high flow oxygen, give IV antibiotics, give fluid
Oxygen target levels, normal and COPD?
94-98%,
COPD 88-92%
Delivery of oxygen if critically unwell and if not critically unwell
if critically unwell high flow non rebreather face mask 15L/minute,
if not critically unwell then titrate to oxygen sats
If Oxygen delivery concern measure what?
measure sats,
measure ABG
Blood cultures should be done when?
minimum one set of blood cultures ideally before antibiotics however shouldn’t delay antibiotics
Sources of infection from most common to least- don’t need to know percentages just for reference
pneumonia 50%, urinary tract 20%, abdomen 15%, skin, soft tissue, bone and joint 10%, endocarditis 1%, device related 1%, meningitis 1%, others
Every hour of delay in antibiotic administration is associated with increase in mortality of 7%. IV antibiotics should be administered when?
ASAP, within the first hour,
ideally to the most likely source but if unknown then unknown according to local guidance
IV antibiotics in sepsis when unknown source in Tayside
IV amoxicillin + metronidazole + gentamicin
IV fluid challenge in sepsis: how much and what type?
prescribe 250-500mls over 15mins,
crystalloid - 0.9% saline or Hartmanns
With IV fluid challenge what is aim for MAP?
MAP > 65mmHg
With IV fluid challenge what is aim for first 3 hours?
30ml/kg
If no response in BP to fluids then what is management?
consider early transfer to MHDU for CVC +/- vasopressors (noradrenaline)
High lactate in sepsis is a sign of what?
sign of hypo perfusion as is sign of anaerobic respiration
If lactate is >4, how often should this be repeated?
every 4-6hours
What does urine output measure?
marker of organ perfusion and cardiac output
Target Urine output?
0.5ml/kg/hr
How is urine output measured most accurately?
catheter insertion
Fluid balance charts include monitoring of what and should be commenced when?
output,
input,
insensible losses e.g. sweating, respiration,
should be commenced when Catheter inserted
What is management aims for hours 2-6 having completed sepsis 6?
regular reassessment, aim 30ml/kg of fluid in first 3 hours, aim MAP >65mmHg, aim urine output >0.5ml/kg/hr, aim improve NEWS
What are 4 concerning signs in deteriorating patient with sepsis?
new confusion,
high RR,
low BP,
low BM
CVC in detiorating patient for what?
to guide central venous pressure,
administer vasopressors
If NEWS 1-4, need 4 hourly observations and what is action?
nurse assessment within 60 mins
If NEWS 5-6, or 3 in one parameter, need 1 hourly observations and what is action?
medical review within 30 mins
If NEWS 7 or more, need minimum 15 mins observations, continuous cardiac monitoring and what is action?
senior review within 15mins
