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Code sepsis

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Code sepsis

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

Transcript

  • 1. CODE SEPSIS By Kane Guthrie FCENA
  • 2. Sepsis • Why Code Sepsis • R/V evidence in sepsis care • Approach to the septic patient • Resuscitating & managing sepsis
  • 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. Sepsis the Problem! • Major public health problem • High Mortality • Comprises 12% of ICU admits • Burden of death 3x that of national road toll
  • 5. Sepsis Pitfalls • Fail to recognise/screen for sepsis • Under appreciate the mortality • Failure to respect as Time Critical Illness
  • 6. The Current Code’s Trauma STEMI Stroke
  • 7. The Current Code’s Trauma STEMI Stroke 7% 5% 8% Mortality Mortality Mortality
  • 8. Septic Shock Mortality
  • 9. Septic Shock Mortality
  • 10. Risk Factors!
  • 11. Symptoms of Sepsis
  • 12. Risk Assessment
  • 13. Where to Look • Respiratory • 35% • Urinary Tract • 35% • Intra Abdominal • 10% • Unknown • 10% • Meningitis/septic • 10% arthritis/skin/vascular access devices
  • 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. Lactate • Reflects cellular hypoxia – Hypoperfusion • Rise’s early in shock development • Lactate ^4mmol - panic value • Repeat – assess lactate normalisation
  • 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. The Game Plan
  • 18. The Goals of Sepsis Tx! 1. 2. 3. 4. Respiratory support Maintain circulating blood volume Immediate antibiotic administration Removal of source
  • 19. The approach • • • • • • • Airway Breathing Circulation Disability Environment Senior DR to R/V Ensure IV access
  • 20. The Sepsis Six 1. 2. 3. 4. 5. 6. Give Oxygen Blood Cultures IV antibiotics Fluid challenge Check lactate Urine output
  • 21. Respiratory Support Hypoperfused tissue = oxygen depleted ↓ Respiratory rate increases ↓ Compensatory mechanism ↓ Results in metabolic acidosis
  • 22. Give them O2 • Supplemental O2 – maximise O2 available • Use High flow – Cautious in COPD • Aim for SPO2 >95%
  • 23. When the Lungs Fail • High risk of ARDS • May require NIV – CPAP or BiPAP for more support • This fails = mechanical ventilation
  • 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. Hypotension is Bad • Sepsis = vascular depleted! Results in: • Peripheral hypoperfusion • Myocardial dysfunction All this = Hypotension
  • 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. When Fluids Fail Need to improve hearts: • Contractility • Cardiac out Use Vasoactives • Noradrenaline • Vasopressin • Dopamine
  • 28. Which Pressor is Best?
  • 29. Which Pressor is Best? Noradrenaline seems to be popular ATM!
  • 30. Time to be Invasive
  • 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. 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. Kumar Study!
  • 34. Steroids: Friend or Foe?
  • 35. Role of Roid’s
  • 36. Role of Roid’s Consider in vasopressor resistant shock
  • 37. Source Control Aim to: • Control focus of infection • Facilitate restoration of optimal A & P Through: • Drainage, debridement, removal
  • 38. Source Control
  • 39. Being Supportive • • • • • Pressure area care Stress ulcer prophylaxis DVT prophylaxis Glucose control Family support
  • 40. Complications of Sepsis
  • 41. Questions
  • 42. Take Home Points Sepsis: – Time sensitive disease – Be suspicious & look for it – Requires early intervention • Antibiotics & fluids within 1 hour!