Sepsis 3 Flashcards
Sepsis Guidelines: First 3 hrs in ED
1) Start an IV (1 or 2) and draw blood
2) Check O2 via pulse Ox, give 2-4 L of O2
3) Get them on EKG/monitor & Vitals
4) Get a culture from sputum and blood
Need Physician order for:
5) Antibiotics: Vancomycin, Levoquin, Flagyl, Rocephin
6) Normal Saline Solution (2-3 L), want MAP >65 and CVP 8-12
7) Foley to measure urine output
8) CXR or CT (diagnostic test)
Sepsis Guidelines: >6 Hrs (ICU)
1) Put in a hemodynamic catheter (precep Cath: monitors CVP, SCVO2, cardiac output)
2) ART line: give BP and way to draw blood
3) Draw more blood: lactate level, CRP, D dimer (see whats going on), platelet counts
4) Intubate and give PAP or PEEP (increase pressure) PRONE them (turn regardless every 2 hrs)
5) Sedate (precede aka dexmethetomadate)
6) Give Diuretic (Lasix) & Antibiotics for ARDS
7) Give vasopressor (Norepi and vasopressin) for DIC** and heparin for platelets/FFP
8) Nutrition (enteral feedings, glucose control (insulin drip), dialysis (CRRT), Reglan IV
9) Lovenox (to prevent DVT)
normal pCO2
35-45
HCO3
22-26
paO2
80-100
ScVO2
70-80
first phase of septic shock
warm: hyperdynamic
s/s of warm first phase of septic shock
Increased C.O. Peripheral vasodilation Decreased SVR Change LOC Rapid, shallow breathing Decreased urine output Rapid, bounding pulse
second phase of septic shock
Decreased C.O. Vasoconstriction Increased SVR Inadequate tissue perfusion Pale, cyanotic Mottling extremities Absent urine output
treatment of septic shock
*find the cause of infection (do whole panel of lab work and blood cultures (2 cultures: 1) aerobic and THEN 2) anaerobic)
Remove source of infection
Aggressive antibiotics
Vasopressors with Epinephrine or Norepi and Vasopressin
Mechanical ventilation
Sedation- BIS sedation monitor
when do you give antibiotics and fluids if septic shock
before cultures even come back (if suspected/criteria)
what are blood cultures checking for
checking for sepsis: has infection gone from the site of origin to generalized blood stream??
what is often the first indication of DIC
petechiae
sepsis is the _____ most
common principal reason for
hospitalization in the U.S. with
6th
what is sepsis
Way the immune system responds to infection
what can DIC lead to
Become gangrenous and clot off (cause perfusion, lose peripherals/limbs)
6 Steps of Sepsis Protocol: separated into 6 hr time frame
1) High Flow oxygen
2) blood cultures
3) IV antibiotics
4) IV fluid resuscitation (crystalloids)
5) measure lactate
6) measure urine output and strict fluid balance
during the first 6 hours of sepsis what are the goals
1) Oxygen, lab work, etc
2) **GOAL keep CVP up (8-12) and want BP to be good so give 2-3 L of saline
3) Give oxygen at 4 L
4) Systemic venous oxygenation: want 70-80
goals of initial resuscitation
a) CVP 8–12 mm Hg
b) MAP ≥ 65 mm Hg
c) Urine output ≥ 0.5 mL/kg/hr
d) Scvo2 ≥ 70%. Systemic venous oxygenation (still being delivered to organs in body)
what is a presep sepsis catheter
short line, goes in like a swan and measures venous oxygenation and ScvO2
what are crystalloids
saline
Sepsis and septic shock are ___________
medical emergencies
first steps in sepsis diagnosis
Identify SOURCE: use blood cultures, wound, sputum
Start antibiotics IMMEDIATELY before culture comes back
what meds are recommended for sepsis (priority)
combination antibiotics-broad spectrum (usually at least two, anaerobic and aerobic)
