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Sepsis resuscitation bundle

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