Septic Shock Administrative Guideline Flashcards
History
- Duration and severity of fever
- Past medical history
- Medications / Recent antibiotics
- Immunocompromised (transplant, HIV,
diabetes, cancer) - Last acetaminophen or ibuprofen
Signs and symptoms
- Fever/chills
- Altered mental status
- Delayed capillary refill
- Chest pain, cough, headache,
abdominal pain, dysuria - Nausea, vomiting, diarrhea
Differential
Infection - pneumonia, UTI, cellulitis, abscess, gastrointestinal - Malignancy - Heat related illness - Hyperthyroid - Meningitis - Hyperglycemia/hypoglycemia - Overdose (sympathomimetic, anticholinergic)
Do you suspect sepsis?
Good. Keep your senses sharp. Suspect sepsis at all times. Its never lupus. Always sepsis.
Do they have positive sepsis screening elements from 1 + 2 + 3?
Administer oxygen and titrate to SaO2 of ? 94%
Temperature measurement (if available)
IV/IO access, EtCO2 monitoring
Administer 30 mL/kg NS/LR fluid bolus (max 3 L)
Reassess every 500 mL and hold administration if
patient develops signs of fluid overload
Shock AG if indicated
Sepsis screening 1
Suspected Infection or immunosuppression
High Risk Pediatric Patients
Sepsis screening 2 adult
Two or more markers of Systemic Inflammatory Response Syndrome (SIRS): Temp ≥ 100 or ≤ 97 HR ≥ 90 RR ≥ 20 Glucose > 140 in non-diabetic Altered mental status
Sepsis screening 2 pedatric
Pediatric 0-2 y 2-10 y 10-14 y HR >190 >140 >100 RR >50 >34 >30 Capillary refill delayed > 2 sec Mental status: decreased arousability, irritable,
Sepsis screening 3 adult
Findings of Shock: SBP < 90 or MAP < 65 or SBP drop of 40 mmHg from prior baseline ETCO2 ≤ 25 O2 sat ≤ 92% on RA Mottled or cold extremities Central cap refill ≥ 3 seconds Purpuric rash No radial pulse
Sepsis screening 3 pedatric
Pediatric
SBP <70 + (age in yr x 2)
3 or more exam criteria
2 or more exam criteria in high risk patient
3 categories of sepsis
- Sepsis - a suspected infection with 2 or more SIRS criteria (tachypnea, tachycardia, abnormal
temperature, and a white blood cell abnormality on lab draw) - Severe sepsis - sepsis with the presence of organ dysfunction, such as AMS or hypotension. Lactate, a
consequence of tissue metabolism, rises when organ dysfunction is present. Severe sepsis is
responsive to fluid resuscitation. - Septic shock - severe sepsis and poor perfusion, unimproved after fluid bolus
Quantitative waveform capnography
can be used as a surrogate for lactate monitoring in detecting metabolic acidosis. EtCO2< 25 mm Hg are associated with serum lactate levels > 4 mmol/L, indicating severe sepsis/septic shock.
Get large 2x large bore IVS if you can
but don’t delay transport if you can’t.
IV fluids and sepsis patients
suspected septic patients should receive repeated fluid boluses while being checked frequently
for signs of pulmonary edema (particularly in dialysis and CHF patients). Stop fluid infusion in the
setting of pulmonary edema; re-evaluate lung exams every 500 mL of fluid.
What’s your supplemental O2 goal?
titrate to oxygenation saturation greater or equal to 94%. Septic patients are especially susceptible to traumatic lung injury and ARDS.
