Goal and Objectives<br />Goal-<br />To decrease mortality from severe sepsis in adults through education and implementation of evidenced-based care bundles<br />Objectives-<br />Recognize the signs and symptoms of sepsis<br />Understand the difference between the types of sepsis; SIRS, sepsis, severe sepsis, and septic shock<br />Learn the sepsis resuscitation care bundle<br />Audience-<br /> Nurses<br />
What is sepsis?<br />Sepsis is a condition in which the body is fighting a severe infection that has spread via blood stream. This is characterized by a systemic inflammation response syndrome called, SIRS. The body may develop this inflammatory response to microbes in the blood, urine, lungs, skin, or other tissues. <br />There is a continuum to sepsis that includes infection, sepsis, severe sepsis, septic shock, and multiple organ dysfunction<br />
Systemic Inflammatory Response Syndrome (SIRS)<br />Two or more of:<br />Temperature >38˚C or <36˚C<br />Heart rate >90 (unless taking beta-blocker, calcium channel blocker, or the heart is paced<br />Respiratory rate >20 breaths/min or PaCO2 < 32 mmHg<br />WBC >12,000 or < 4,000 <br />
Types of sepsis<br />Sepsis: <br />Two or more SIRS criteria, known or suspected infection<br />Severe sepsis:<br />Sepsis as above<br />Organ dysfunction<br />-hypotension: systolic <90 mmHg, MAP <65 mmHg, or a decrease in 40 mmHg from usual reading<br />-Lactate > 4mmol/L<br />-Altered mental status<br />-Hyperglycemia in the absence of diabetes<br />-Hypoxemia, O2 < 93%<br />-UOP <0.5 ml/kg/hr and/or raised urea or creatinine <br />-Coagulopathy, INR >1.5<br />
Sepsis Continued<br />Septic shock:<br />Severe sepsis<br />Hypotension or raised lactate that does not improve with adequate fluid resuscitation<br />Multiple organ dysfunction:<br />Perfusion is compromised, ischemia and hypoxia of organs<br />Cardiovascular-Heart Failure, Neurological- change in LOC, Pulmonary-ARDS, Renal- Acute Renal Failure, Metabolic-acidosis, Hepatic- Liver Failure, Hematologic-Disseminated Intravascular Clotting<br />
Sepsis<br />Identifying patients with severe sepsis in primary care, emergency departments, wards or admission units is crucial to reducing mortality<br />In the severe sepsis resuscitation bundle, a time limit of six hours is given for all elements to be completed, although elements should be completed as soon as possible.<br />
Sepsis Resuscitation Bundle<br />Measure serum lactate<br />Blood cultures obtained prior to administration of antibiotic<br />From time of presentation, broad spectrum antibiotics must be administered within 3hrs of ED admission, or within 1hr of non-ED admission<br />In the event that hypotension and/or serum lactate >4mmol<br /> a) Deliver initial minimum of 20ml/kg of crystalloid or colloid equivalent.<br /> b) Apply vasopressors for hypotension not responding to initial fluid resuscitation to maintain a MAP of ≥65mmHg.<br />Consider insertion of urinary catheter (measure UOP)<br />If hypotension persists and serum lactate >4mmol despite fluid resuscitation achieve<br /> a) CVP ≥8mmHg and<br /> b) (ScvO2) of ≥70%.<br />
Were Objectives Met?<br />Can you recognize inflammation through signs such as redness, heat, swelling, pain and loss of function? <br />Are you aware of changes in vital signs; tachycardia, hypotension, decrease in O2, increase in respirations?<br />What labs should you monitor aggressively?<br />Do you have a better understanding of the need for urgent fluid resuscitation to reverse hypovolemia that has occurred from sepsis?<br />Did this information help you interpret physiological observations to decrease mortality rate in adults with sepsis?<br />
References<br />Carter, C. (2007). Implementing the severe sepsis care bundles outside the ICU by outreach. British Association of Critical Care Nurses, Nursing in Critical Care, 12 (5), 225-230<br />Peel, M. (2008). Care bundles: resuscitation of patients with severe sepsis. Nursing Standard, 23 (11), 41-46<br />Simrandeep, S., Pradeep, S., Gurjit, S. (2009). Systemic inflammatory response syndrome outcome in surgical patients. Indian Journal of Surgery, 71, 206–209<br />
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