George Adolf
Myths The elderly, for the most part are  the only people who contract sepsis. Sepsis only affects people with pre-  exi...
Incidence Over 750,000 patients are  diagnosed with sepsis annually,  with an increase of 90% in the  number of diagnoses...
Mortality In otherwise healthy individuals, the  mortality rate for sepsis is 5% If severe sepsis develops, mortality  r...
At-Risk Populations Elderly, infants, surgical patients,  chronically ill and immuno-  supressed patients are all at  inc...
Definitions a.      Sepsis – a SIRS response triggered by  infection b.      Septicemia – sepsis originating from an  in...
S/S of Sepsis a.   Chills, low grade fever, shaking,  body aches, N&V, vertigo, other flu-like  symptoms b.   Occasional...
Purpura/rash inchildren with sepsiscaused bymeningococcalinfection
Influenza vs. SepsisSepsis can be misdiagnosed as theflu because symptoms are nearlyidentical often. Try to rule outsepsis...
Sources of Infection Dirty wounds (debris) Complex wounds (open fractures) Burns Puncture wounds Impaled Objects Cru...
Infected Wounds
Progression of Sepsis a. Local infection occurs triggering non-specific  inflammatory cell response      i.      Vasodil...
Sepsis Chain
Image: various causes & signs of infection/sepsis
Progression of Sepsis                  cont. b.    Local Inflammatory Response  Ineffective > infection spreads beyond  o...
Progression of Sepsis                  cont. d.       Severe sepsis        i. Organ dysfuntion, poor perfusion or       ...
Progression of Sepsis                  cont. e.       Septic Shock        i. When aggressive fluid replacement and      ...
Progression of Sepsis                  cont. f.   Multiple organ dysfunction  Syndrome    i. Two or more organs fail to ...
Assessment a. ABCs, manage critical problems b. Complete SAMPLE hx      i.    How long has pt been ill?      ii.   Is ...
A sign of infectionA bad IV site
Management of Sepsis a.      Oxygen – patients with sepsis have an  increased oxygen demand, oxygen supply to  tissue is ...
Management of Sepsis                cont. d.     Monitor hypotension and use fluid  replacement, Trendelenburg position t...
Keep in mind:Septic patients are prone to rapiddeterioration, ALS providers should beutilized if available  rapid transpo...
Sepsis project presentation
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Sepsis project presentation

  1. 1. George Adolf
  2. 2. Myths The elderly, for the most part are the only people who contract sepsis. Sepsis only affects people with pre- existing conditions. Sepsis is the same thing as blood poisoning (septicemia). Sepsis and septic shock are always fatal.
  3. 3. Incidence Over 750,000 patients are diagnosed with sepsis annually, with an increase of 90% in the number of diagnoses over the last 10 years. The cause for this is believed to be the rise of drug-resistant bacteria
  4. 4. Mortality In otherwise healthy individuals, the mortality rate for sepsis is 5% If severe sepsis develops, mortality rises sharply If hypotension (the hallmark of septic shock) is present, mortality rises to 50%
  5. 5. At-Risk Populations Elderly, infants, surgical patients, chronically ill and immuno- supressed patients are all at increased risk of contracting sepsis because of compromised or diminished immune function. The mortality rates for these catagories are also raised.
  6. 6. Definitions a. Sepsis – a SIRS response triggered by infection b. Septicemia – sepsis originating from an infection in the bloodstream c. Systemic Inflammatory Response Syndrome – systemic (bodywide) immune response meeting two or more of the following criteria  i. Temperature above 100.4 ˚F , below 96.8 ˚F  ii. HR > 90 bpm  iii. RR > 20 or PaCO2 < 32 mmHg  iv. Extreme high/low WBC count
  7. 7. S/S of Sepsis a. Chills, low grade fever, shaking, body aches, N&V, vertigo, other flu-like symptoms b. Occasional AMS including confusion, lethargy and increased fatigue
  8. 8. Purpura/rash inchildren with sepsiscaused bymeningococcalinfection
  9. 9. Influenza vs. SepsisSepsis can be misdiagnosed as theflu because symptoms are nearlyidentical often. Try to rule outsepsis when considering a diagnosisof influenza.
  10. 10. Sources of Infection Dirty wounds (debris) Complex wounds (open fractures) Burns Puncture wounds Impaled Objects Crush Injuries
  11. 11. Infected Wounds
  12. 12. Progression of Sepsis a. Local infection occurs triggering non-specific inflammatory cell response  i. Vasodilation occurs allowing more blood to reach infected area enhancing immune response by allowing increased movement of antibodies and immune cells (Phagocytes) into affected area in order to combat infection  ii. Increased Local Vessel Permeability Increases, permits antibodies & phagocytes to move out of bloodstream into surrounding infected cells
  13. 13. Sepsis Chain
  14. 14. Image: various causes & signs of infection/sepsis
  15. 15. Progression of Sepsis cont. b. Local Inflammatory Response Ineffective > infection spreads beyond original location c. Body initiates systemic inflammatory response to infection > infection becomes sepsis at this point
  16. 16. Progression of Sepsis cont. d. Severe sepsis  i. Organ dysfuntion, poor perfusion or hypotension  ii. Characterized by: hypotension (<90 mmHg systolic), altered mental state, hyperglycemia w/o Hx of diabetes, hypoxemia, & decreased urine output  iii. Body’s response to severe sepsis > release of histamines, prostaglandins, cytokines causing systemic vasodilation and increased capillary permeability> fluid shift from intravascular space to the extravascular space > increased systemic inflammation & relative hypovolemia causing hypotension
  17. 17. Progression of Sepsis cont. e. Septic Shock  i. When aggressive fluid replacement and vasopressors fail to maintain a SBP of at least 90 w/ continued signs of severe sepsis > pt now in septic shock (tx increasingly difficult, mortality now over 50%)
  18. 18. Progression of Sepsis cont. f. Multiple organ dysfunction Syndrome  i. Two or more organs fail to function properly, homeostasis not maintained without aggressive interventions  ii.MODS will develop within 3-5 days of uncorrected septic shock  iii. Final stage of an infection that has overtaken the body > death shortly
  19. 19. Assessment a. ABCs, manage critical problems b. Complete SAMPLE hx  i. How long has pt been ill?  ii. Is there any hx of infections?  iii. Prior medical complications/conditions?  iv. Any surgeries?  v. Pain or fever? c. Complete physical exam  i. Sick/Not Sick  ii. Signs of infection?
  20. 20. A sign of infectionA bad IV site
  21. 21. Management of Sepsis a. Oxygen – patients with sepsis have an increased oxygen demand, oxygen supply to tissue is often inadequate even with supplemental O2 in patients with severe sepsis b. Ventilatory Support – patients with severe sepsis often require mechanical ventilatory support, consider intubation and the use of a respirator if available c. Capnography and Pulse Oximetry to maintain SpO2 above 90, and monitor PaCO2 – respiratory alkalosis (PaCO2 < 32 mmHg) is common
  22. 22. Management of Sepsis cont. d. Monitor hypotension and use fluid replacement, Trendelenburg position to maintain adequate BP e. Initiate IV access – consider large bore IVs for aggressive Tx with crystalloid solutions, bolus in 500 mL increments to maintain SBP of at least 90 mmHg f. Consider vasopressors (dopamine) for pts not responsive to fluid boluses g. Once infection successfully located or suspected consider IV antibiotics if available – some EMS agencies are beginning to carry drugs such as Rocephin
  23. 23. Keep in mind:Septic patients are prone to rapiddeterioration, ALS providers should beutilized if available  rapid transport if airway compromise or inadequate respiration; registers V,P, or U on AVPU scale; unstable vitals or oral temperature > 100˚F

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