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SEPSIS3rdNovember 2011Dr. Vimal Desai
∗ What is sepsis?∗ Why should we be worried?∗ How to assess∗ How to manageAIMS
What is sepsis?
∗ Body’s response to infectionWhat is sepsis?
Why is it important?
∗ Sepsis is common∗ SEPSIS KILLS!!! (36,800 deaths in UK in 2005)∗ Early intervention saves lives (in a study of over15,00...
SIRS
∗ 2 or more of...∗ Temp >38oC or < 36oC∗ HR > 90∗ WCC >12 or <4∗ RR > 20 or PaCO2 < 4.2SIRS
Sites of infection
Sites of infection∗ Chest∗ Urine / reproductive♀∗ GI∗ Biliary∗ Cannula site∗ Bone / joint / disc∗ CNS∗ Endocarditis∗ ENT∗ ...
SIRS + Infection = SEPSIS
Other causes of SIRS
∗ Trauma∗ Major surgery∗ Blood transfusion∗ Pancreatitis∗ PE∗ ACSOther causes of SIRS
Surviving Sepsis Campaign
First hour care in sepsis or ‘sepsis six’
∗ High flow oxygen∗ Peripheral blood cultures∗ IV antibiotics (as per local policy)∗ Fluid resuscitate∗ Serum lactate∗ Mea...
Next step...
Evidence of organ dysfunction
∗ SBP < 90 / MAP < 65 / fall of 40mmHg∗ Urine output < 0.5 ml / kg / h for adults∗ INR > 1.5∗ Bilirubin > 34∗ Lactate > 2∗...
Sepsis + Organ Dysfunction = SEVERE SEPSISMortality = 35%
∗ PaO2 < 8 or SaO2 < 85% on 100% O2 or PaCO2 > 7 (>9if chronic) or exhaustion∗ Stridor, tracheal tug or see-saw chest∗ SBP...
If severe sepsis results in SBP < 90 / MAP < 65 / a fall of40mmHg or lactate > 4↓SEPTIC SHOCKMortality = 50%
Six hour resuscitation bundle
∗ Further fluid resuscitation if indicated∗ Ensure Hb > 7 g / dl∗ If still shocked (low BP / urine output / high↓lactate) ...
∗ APACHE II score∗ ?Low tidal volume ventilation∗ Ventilation care bundle∗ Hydrocortisone∗ ?vasopressin∗ ?Activated protei...
∗ Assessment of sepsis∗ Management of sepsisSummary
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Transcript of "Sepsis (3rd nov_2011)[1]"

  1. 1. SEPSIS3rdNovember 2011Dr. Vimal Desai
  2. 2. ∗ What is sepsis?∗ Why should we be worried?∗ How to assess∗ How to manageAIMS
  3. 3. What is sepsis?
  4. 4. ∗ Body’s response to infectionWhat is sepsis?
  5. 5. Why is it important?
  6. 6. ∗ Sepsis is common∗ SEPSIS KILLS!!! (36,800 deaths in UK in 2005)∗ Early intervention saves lives (in a study of over15,000 patients across 30 countries over 2 years,mortality fell by 20%)Why is it important?
  7. 7. SIRS
  8. 8. ∗ 2 or more of...∗ Temp >38oC or < 36oC∗ HR > 90∗ WCC >12 or <4∗ RR > 20 or PaCO2 < 4.2SIRS
  9. 9. Sites of infection
  10. 10. Sites of infection∗ Chest∗ Urine / reproductive♀∗ GI∗ Biliary∗ Cannula site∗ Bone / joint / disc∗ CNS∗ Endocarditis∗ ENT∗ Prosthesis∗ Skin / soft tissue / wound∗ Other
  11. 11. SIRS + Infection = SEPSIS
  12. 12. Other causes of SIRS
  13. 13. ∗ Trauma∗ Major surgery∗ Blood transfusion∗ Pancreatitis∗ PE∗ ACSOther causes of SIRS
  14. 14. Surviving Sepsis Campaign
  15. 15. First hour care in sepsis or ‘sepsis six’
  16. 16. ∗ High flow oxygen∗ Peripheral blood cultures∗ IV antibiotics (as per local policy)∗ Fluid resuscitate∗ Serum lactate∗ Measure hour fluid balance (?catheterise)First hour care in sepsis or ‘sepsis six’
  17. 17. Next step...
  18. 18. Evidence of organ dysfunction
  19. 19. ∗ SBP < 90 / MAP < 65 / fall of 40mmHg∗ Urine output < 0.5 ml / kg / h for adults∗ INR > 1.5∗ Bilirubin > 34∗ Lactate > 2∗ O2 needed to keep SaO2 > 90% (new)∗ Platelets < 100∗ Creatinine > 177∗Evidence of organ dysfunction
  20. 20. Sepsis + Organ Dysfunction = SEVERE SEPSISMortality = 35%
  21. 21. ∗ PaO2 < 8 or SaO2 < 85% on 100% O2 or PaCO2 > 7 (>9if chronic) or exhaustion∗ Stridor, tracheal tug or see-saw chest∗ SBP < 90mmHg despite resuscitation∗ pH < 7.15 or lactate > 6 (>4 after resus.)∗ Seizures∗ GCS < 9∗ Arrest∗ EES > 8Consider ITU referral if...
  22. 22. If severe sepsis results in SBP < 90 / MAP < 65 / a fall of40mmHg or lactate > 4↓SEPTIC SHOCKMortality = 50%
  23. 23. Six hour resuscitation bundle
  24. 24. ∗ Further fluid resuscitation if indicated∗ Ensure Hb > 7 g / dl∗ If still shocked (low BP / urine output / high↓lactate) insert central line and ensure CVP = 8-12mmHg; consider noradrenaline or dopamine∗ Check ScvO2; consider dobutamine if <70%Six hour resuscitation bundle
  25. 25. ∗ APACHE II score∗ ?Low tidal volume ventilation∗ Ventilation care bundle∗ Hydrocortisone∗ ?vasopressin∗ ?Activated protein CITU
  26. 26. ∗ Assessment of sepsis∗ Management of sepsisSummary
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