Resuscitation in Sepsis Flashcards
What is Sepsis?
NEWS score of 5 or more and a suspicion that the patient has an infection, Thats sepsis.
What is Septic Shock
Subset of sepsis where particularly profound infection overwhelms the host response.
Organ Dysfunction
What ages are patients at higher risk of sepsis
<1 yr and >75 yrs
What are risk factors for sepsis
- Chemotherapy
- Diabetes
- Long term steroids
- Immunosuppressant drugs
- Pregnancy
What clinical signs indicates prompt intervention despite NEWS < 5
Mottled skin
Non-blancing rash
known neutropenia
Post sepsis patients
On Immunosuppression
Identifying septic shock
Subset of sepsis with circulatory, cellular and metabolic dysfunction.
When BP drops despite adequate fluid resus resulting in organ hypo-perfusion.
Anaerobic respoiration begins, and the serum lactate levels rise.
When should SEPSIS6 aim to have been initiated by?
Within 1 hour of Diagnosing sepsis.
SEPSIS6 : GIVE OXYGEN
Why:
- Imbalance between O2 demand and supply in sepsis.
- Correcting low sats reduces tissue hypoxia.
How:
- Start O2 at sats <92%
- Aim for 94-98%
- If risk of hypercarbia aim 88-92%
(ABG if concerned, useful rapid information on oxygenation and metabolic dysfunction - Patients with COPD, Lung disease etc…)
SEPSIS6 : TAKE BLOODS
Why:
- Laboratory tests help to stratify the risk and identify the pathogens and allow targeted therapy.
How:
- At least 1 set (Pair) of blood cultures. (10ml in each)
- Additionally; FBC; Ues; LFTs; CRP; Clotting; Lactate.
- Consider the source at this point.
(clinical examination findings to determine other tests e.g. Swabs, Urine, Stool)
SEPSIS6 : GIVE IV ABX
Why:
- Source Control
- Reduce Immune stimulus
How:
- Maximum dose broad spectrum IV therapy.
- Consider local policy and Allergens.
- Choice guided by suspected focus of infection.
- Administration as soon as feasibly possible.
ANTIBIOTIC MAN IS EMPIRICAL AND USED TO GIVER GENERAL ABX AT THIS POINT!
SEPSIS6 : GIVE FLUID CHALLENGE
Why:
- Hypovolaemia contributes to shock
- Restoring circulating volume can help correct hypovolaemia.
- Bring HR, BP, Mental state, Lactate and urine output to within target.
How:
- 20mls/kg in boluses. (250-500ml over 15 mins - then reassess) (keep going if parameters are still out)
- Crystalloid fluid.
- Consider px size (diff in paeds)
- Hx of heart failure.
What Fluids in Fluid Challenge?
Any Crystalloid (Hartmann’s, Plasmalyte, 0.9% sodium chloride)
DON’T GIVE ANYTHING WITH SUGAR.
- Very little fluid remains in the extravascular space so patient will lose this quickly and deteriorate again.
SEPSIS6 : MEASURE LACTATE
Why;
- Sepsis is a dynamic state
- Lactate can help guide fluid therapy
- Highlights patients who are not responding appropriately.
- Helps to guide need for early HDU/ICU referral.
- Lactate is a good marker for how the sepsis is progressing/how treatment is working.
How:
- Up to hourly, if initially elevated, or clinical condition changes.
(Lactate routinely measured on ABG)
SEPSIS6 : MEASURE URINE OUTPUT
Why;
- Sepsis is a dynamic state
- Urine ouput gives another window on circulation (as CO falls so does UO)
- Urine output helps guide fluid therapy
- Urine output helps guide whether BP is normal or not.
How:
- Aiming for > 30mls/kg/hr
- May require Catheter if retention.
What is evidence or non-response? (ship them off to HDU)
- Lactate remains > 4 following fluid challenges to 20ml/kg.
- MAP remains <65mmHg then add vasopressors via central venous access (cannot be done on ward needs to go HDU)
