Code sepsis

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Code sepsis

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  • Remind them to check invasive devices for infection,
  • Remember lactate above 7 stairway to heaven
  • Generally after 60ml/kg boluses
  • Code sepsis

    1. 1. CODE SEPSIS By Kane Guthrie FCENA
    2. 2. Sepsis • Why Code Sepsis • R/V evidence in sepsis care • Approach to the septic patient • Resuscitating & managing sepsis
    3. 3. SEPSIS • Sepsis is a common lifethreatening condition that occurs when a once localised bacterial/fungal infection becomes systemic & produces an unregulated inflammatory immune response.
    4. 4. Sepsis the Problem! • Major public health problem • High Mortality • Comprises 12% of ICU admits • Burden of death 3x that of national road toll
    5. 5. Sepsis Pitfalls • Fail to recognise/screen for sepsis • Under appreciate the mortality • Failure to respect as Time Critical Illness
    6. 6. The Current Code’s Trauma STEMI Stroke
    7. 7. The Current Code’s Trauma STEMI Stroke 7% 5% 8% Mortality Mortality Mortality
    8. 8. Septic Shock Mortality
    9. 9. Septic Shock Mortality
    10. 10. Risk Factors!
    11. 11. Symptoms of Sepsis
    12. 12. Risk Assessment
    13. 13. Where to Look • Respiratory • 35% • Urinary Tract • 35% • Intra Abdominal • 10% • Unknown • 10% • Meningitis/septic • 10% arthritis/skin/vascular access devices
    14. 14. How to Look for Sepsis • • • • • • • FBC, U&E, CRP,Coags, Lactate Blood cultures x2 (Indwelling devices) MSU CXR Swabs Sputum Consider – US, CT, LP (case specific)
    15. 15. Lactate • Reflects cellular hypoxia – Hypoperfusion • Rise’s early in shock development • Lactate ^4mmol - panic value • Repeat – assess lactate normalisation
    16. 16. Blood Cultures • Taken when infection suspected • Best during fever (high rate of capturing organism) • From IV & Invasive devices • Before antibiotics – But don’t delay Ab’s !
    17. 17. The Game Plan
    18. 18. The Goals of Sepsis Tx! 1. 2. 3. 4. Respiratory support Maintain circulating blood volume Immediate antibiotic administration Removal of source
    19. 19. The approach • • • • • • • Airway Breathing Circulation Disability Environment Senior DR to R/V Ensure IV access
    20. 20. The Sepsis Six 1. 2. 3. 4. 5. 6. Give Oxygen Blood Cultures IV antibiotics Fluid challenge Check lactate Urine output
    21. 21. Respiratory Support Hypoperfused tissue = oxygen depleted ↓ Respiratory rate increases ↓ Compensatory mechanism ↓ Results in metabolic acidosis
    22. 22. Give them O2 • Supplemental O2 – maximise O2 available • Use High flow – Cautious in COPD • Aim for SPO2 >95%
    23. 23. When the Lungs Fail • High risk of ARDS • May require NIV – CPAP or BiPAP for more support • This fails = mechanical ventilation
    24. 24. Mechanical Ventilation in Sepsis • • • • • • Use low tidal volumes 6-8ml/kg/IBW Optimise your PEEP Keep plateau pressure <30 Sit them up to 30° Check cuff pressure Avoid hyperoxia
    25. 25. Hypotension is Bad • Sepsis = vascular depleted! Results in: • Peripheral hypoperfusion • Myocardial dysfunction All this = Hypotension
    26. 26. Fluid Resuscitation • Start with fluid bolus: • 20-40ml/kg • Fluid choice – Saline vs CSL • Hb <70 give blood • Look for: ↑BP, ↓HR, ↑Urine Output
    27. 27. When Fluids Fail Need to improve hearts: • Contractility • Cardiac out Use Vasoactives • Noradrenaline • Vasopressin • Dopamine
    28. 28. Which Pressor is Best?
    29. 29. Which Pressor is Best? Noradrenaline seems to be popular ATM!
    30. 30. Time to be Invasive
    31. 31. Renal Dose Dopamine Myth that it prevents: • Acute renal failure • Does increase contractility slightly • Limited evidence in low doses • It works best if ICU don’t want the patient!
    32. 32. Early Appropriate AB’s • • • • • 1st dose within 1 hour Broad spectrum first Greatly reduces mortality Duration 7-10 days Consider antifungals/viral in special pop
    33. 33. Kumar Study!
    34. 34. Steroids: Friend or Foe?
    35. 35. Role of Roid’s
    36. 36. Role of Roid’s Consider in vasopressor resistant shock
    37. 37. Source Control Aim to: • Control focus of infection • Facilitate restoration of optimal A & P Through: • Drainage, debridement, removal
    38. 38. Source Control
    39. 39. Being Supportive • • • • • Pressure area care Stress ulcer prophylaxis DVT prophylaxis Glucose control Family support
    40. 40. Complications of Sepsis
    41. 41. Questions
    42. 42. Take Home Points Sepsis: – Time sensitive disease – Be suspicious & look for it – Requires early intervention • Antibiotics & fluids within 1 hour!

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