Sepsis Resuscitation Flashcards
How can Sepsis be identified?
A NEWS of 5 or more with presence of infection from the patient’s history.
Symptoms of Cough, Dysuria, Abdominal Pain, Abnormal Bloods and Confusion
(Abdominal Pain may indicate Intra-Abdominal Sepsis)
What is the Sepsis 6?
The 6 things you need to do within the FIRST HOUR Of Sepsis Onset.
Take Blood Cultures, Measure Lactate Levels and Urine Output.
Give Oxygen, Fluids and Antibiotics
How do you administer Oxygen in Sepsis?
Titrate to 94-98%.
Check ABGs if you feel patient should be on a lower oxygen titration. ABGs also allow you to assess Metabolic State
What do you need to consider when taking Cultures?
Be ready to take cultures of other bodily substances depending on where the source of infection is e.g. Sputum Cultures along with Blood Cultures.
If there is abscess, call a surgeon for incision and drainage
How are Fluids given in Sepsis?
IV Fluid Challenge of 0.9% Saline or Hartmann’s.
30ml/kg of Body Weight over First 3 Hours for Hypotension and Lactate Levels >4mmol/L
How is Lactate Measured?
What do High Lactate Levels mean?
Lactate is measured via Cannula and remeasured if Levels are >2mmol/L.
High Lactate Levels are indicative of Hypoperfusion and increased mortality.
What does a Low Urine Output mean? How is it Treated?
Low Urine Outputs show Low Organ Perfusion.
Treat with Fluid Balance, aiming for Urine Output of 0.5ml/kg of Body Weight per hour.
What should be done in Hour 2-6 of Sepsis Management?
- Continue Resuscitation
- Aim for NEWS Improvement, Haemodynamic Stability and Reduction in Lactate Levels
- REVIEW REVIEW REVIEW
What are Signs of Septic Shock?
- Deteriorating NEWS Score
- Unresponsive to Treatment
- New Onset/Worsening Confusion
- Tachypnoeic
- Hypotensive
- Low Basal Metabolism
- Hypoglycaemia
What is the Management for Non-Responsive Patients?
- Escalate Care to MHDU
- If Patient’s MAP <65mmHg, give Vasopressor
- If Vasopressor Level is escalating, then Reassess Patient for Source Control, consider Steroid Addition and refer to ICU for Further Vasopressin Treatment
What Vasopressors are used in the treatment of Sepsis?
First Line: Noradrenaline
Second Line: Vasopressin
Third Line: Adrenaline
What is Start SMART?
Deciding if the infection is suitable for antibiotic prescription and what antibiotic should be used to benefit treatment
What are the components of Start SMART?
Take History
Initiate Prompt Effective Antibiotic Treatment within 1hr for Life-Threatening Infections e.g. Sepsis
Comply with Local Protocol Guidance
Document Antibiotic Administration, including Review, Start and Stop Dates
Ensure Relevant Microbiological Specimens are taken
What Antibiotic(s) should be given for Staph. Aureus Sepsis?
IV Flucloxacillin
IV Vancomycin for Flucloxacillin Allergy or in MRSA
In NON-SEPTIC Patients, what Antibiotics are given in Flucloxacillin Allergy in Staph. Aureus?
Oral Doxycycline, Co-Trimoxazole or Clindamycin
Should you give Flucloxacillin in Coagulase Negative Staphylococci?
NO.
Coagulase Negative Staphylococci are Resistant.
What Antibiotic(s) should be given for Staph. Epidermis Sepsis?
IV Vancomycin
Make sure you are dealing with Staph. Epidermis! Does the Patient story fit?
What Antibiotic(s) should be given for Enterococcus Sepsis?
IV Amoxycillin
IV Vancomycin for Amoxycillin Resistance
Oral Co-Trimoxazole for Step-Down
What should you be aware of with Fluid Resuscitation?
Patients with Cardiac or Renal Issues to prevent overload.
What Antibiotic(s) should be given for Gram Negative Sepsis?
IV Gentamicin, except in Anaerobes
Check Antibiotic and MicroMan for more detail
What are common Infectious Causes for Sepsis?
Pneumonia
UTI, causing Urinary Sepsis
Intra-Abdominal Infection, causing Abdominal Sepsis
What is now a Risk Factor for Antibiotic Dosing in Sepsis?
Obesity!
As antibiotic dosing is based on “70kg men”, the struggle is knowing exactly how much antibiotic to give to obese patients.
What is the Most Important Thing to Remember regarding Antibiotic Administration in Sepsis?
Right Antibiotic, Right Scenario, Right Dose, Right Route, Right Patient
Amoxicillin, Metronidazole and Gentamicin are not always the answer!
What organ dysfunctions are encountered in Sepsis?
Non-Cardiogenic Pulmonary Oedema precipitating Respiratory Failure
Renal Failure
Lactic Acidosis
Shock Liver (grossly elevated AST/ALT)
What Inflammatory Markers are Raised in Sepsis?
Interleukin 6
CRP
WBC Count
PLATELETS DECREASE
