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Uncomplicated Sepsis, Severe Sepsis,          & Septic Shock        Susie Brishaber, RN           August, 2012
   All Sepsis categories hold    Tachycardia (HR > 90)    the same general clinical     Warm skin, possibly    manifest...
   Severe Sepsis – in addition to general clinical    manifestations   Is categorized by having one or more vital organs...
   Severe Sepsis –      RENAL SYSTEM:      Serum Creatinine level > /= 177 µ mol/L      Oliguria (Output of < 0.5 ml/K...
   LIVER    ◦ Jaundice    ◦ Increased levels of Hepatic Enzymes        AST > 48 U/L        ALT > 55 U/L        PT > 10...
   NEUROLOGICAL    ◦ Altered LOC    ◦ Altered CNS function    ◦ Encelopathy   ENDOCRINE    ◦ Hyperglycemia (in absence o...
 Skin ◦ Poor tissue perfusion   Lactic Acid Level (>5 mmol/L)   Edema (With fluid management)
   Activity Intolerance   Acute Pain   Anxiety   Chronic Pain   Decreased Cardiac Output   Impaired Gas Exchange
   Process of PES   P = Problem statement/diagnostic label/definition   E = Etiology/related factors/causes   S = Defi...
Etiology/Related      Factors/Causes   Sepsis can be caused    from many different  infections in differentareas of the bo...
   The lungs are the    major source of    infection in severe    sepsis (especially    with hospital-    acquired    inf...
   Infection in the    abdomen, eg, appendicitis,     bowel    problems, gallbladder    infections. When the outer    sur...
   Bacteria enter the skin    through wounds and skin    inflammations; they also    enter the skin and blood    through ...
   Surviving Sepsis Campaign    ◦   Setting Aims    ◦   Establishing Measures    ◦   Creating a Protocol    ◦   Enhancing...
   The goal is to perform all indicated tasks 100%of the    time within the first 6 hours of identification of severe    ...
   4. In the event of hypotension and/or a serum lactate > 4    mmol/L    ◦ a. Deliver an initial minimum of 20 ml/kg of ...
   Efforts to accomplish these goals should begin    immediately, but these items may be completed within 24   hours of ...
   2. Administer drotrecogin alfa (activated) in accordance    with a standardized ICU policy. If not    administered, do...
   Apache II Score   Measure Serum Lactate Levels   Blood cultures   Initiate IV Antibiotic Therapy   Treatment of Hy...
 Broad  Spectrum Antibiotics should  be administered within 3 hours of  suspected Severe Sepsis or Septic  Shock Blood c...
   Treat Hypotension   If presenting with hypotension and/or lactate level of    >4 mmol/L give 20mL/kg of crystalloid s...
   When patients do not respond to initial fluid    resuscitation, use vasopressor therapy to maintain a    MAP > 65mm Hg...
   Blood cultures should be re-evaluated in 48    hours to determine specific antibiotic therapy   Continue monitoring p...
   http://www.survivingsepsis.org/What_You_Should_Kn    ow/Pages/default.aspx   http://www.nigms.nih.gov/Education/facts...
   http://www.survivingsepsis.org/SiteCollectionDocumen    ts/Pathophysiology%20of%20Sepsis%20Phil(2).pdf   Surviving Se...
   Wesley, E., Kleinpell, R., Goyette, R., (2003).    Advances in the understanding of clinical    manifestations and the...
Sepsis powerpoints
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Sepsis powerpoints

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Kindred Healthcare Sepsis Class

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Transcript of "Sepsis powerpoints"

  1. 1. Uncomplicated Sepsis, Severe Sepsis, & Septic Shock Susie Brishaber, RN August, 2012
  2. 2.  All Sepsis categories hold  Tachycardia (HR > 90) the same general clinical  Warm skin, possibly manifestations rash  Hyperthermia (>38  Generalized Weakness degrees Celsius)  High WBC count  Hypothermia (<36 (>12,000 µL-1) degrees Celsius)  Low WBC count  Difficulty Breathing (<4,0000 µL-1) (Tachypnea, >20 BPM)  Coagulation Imbalance
  3. 3.  Severe Sepsis – in addition to general clinical manifestations Is categorized by having one or more vital organs affected ◦ Lungs ◦ Heart ◦ Kidney ◦ Liver ◦ Central Nervous System
  4. 4.  Severe Sepsis –  RENAL SYSTEM:  Serum Creatinine level > /= 177 µ mol/L  Oliguria (Output of < 0.5 ml/Kg/ hr., if adequate fluid resuscitation)  CARDIOVASCULAR:  Hypotension (Systolic < 90 mm Hg, Diastolic < 60mm Hg)  Atria or Ventricular Rhythms  MAP < 65
  5. 5.  LIVER ◦ Jaundice ◦ Increased levels of Hepatic Enzymes  AST > 48 U/L  ALT > 55 U/L  PT > 10.8 seconds  INR > 1.5  PTT > 60 seconds IMMUNILOGICAL ◦ Nosocomial Infection development ◦ Increase Leukocytosis ◦ Fever (>100.0)
  6. 6.  NEUROLOGICAL ◦ Altered LOC ◦ Altered CNS function ◦ Encelopathy ENDOCRINE ◦ Hyperglycemia (in absence of Diabetes, >140) ◦ Weight loss ◦ Cachexia (Muscle atrophy)
  7. 7.  Skin ◦ Poor tissue perfusion  Lactic Acid Level (>5 mmol/L)  Edema (With fluid management)
  8. 8.  Activity Intolerance Acute Pain Anxiety Chronic Pain Decreased Cardiac Output Impaired Gas Exchange
  9. 9.  Process of PES P = Problem statement/diagnostic label/definition E = Etiology/related factors/causes S = Defining characteristics/signs and symptoms
  10. 10. Etiology/Related Factors/Causes Sepsis can be caused from many different infections in differentareas of the body. With each body system, bacteria has a place to grow if given the chance.
  11. 11.  The lungs are the major source of infection in severe sepsis (especially with hospital- acquired infections), with sepsis usually associated with pneumonia.
  12. 12.  Infection in the abdomen, eg, appendicitis, bowel problems, gallbladder infections. When the outer surface of the abdominal organs (called the peritoneum) is involved in the infection, it is called "peritonitis.“ Diabetic patients are also at increased risk of urinary infections leading to sepsis. Sometimes this is referred to as "urosepsis" which just refers to sepsis related to a urinary tract infection. (Surviving Sepsis Campaign)
  13. 13.  Bacteria enter the skin through wounds and skin inflammations; they also enter the skin and blood through an opening provided by intravenous ("IV") catheters (small tubes for dripping fluids), which are required for the administration of fluids and/or medicines.
  14. 14.  Surviving Sepsis Campaign ◦ Setting Aims ◦ Establishing Measures ◦ Creating a Protocol ◦ Enhancing Reliability ◦ Testing Changes
  15. 15.  The goal is to perform all indicated tasks 100%of the time within the first 6 hours of identification of severe sepsis. The tasks are: 1. Measure serum lactate 2. Obtain blood cultures prior to antibiotic administration 3. Administer broad-spectrum antibiotic, within 3 hrs. of ED admission and within 1 hour of non-ED admission
  16. 16.  4. In the event of hypotension and/or a serum lactate > 4 mmol/L ◦ a. Deliver an initial minimum of 20 ml/kg of crystalloid or an equivalent ◦ b. Apply vasopressors for hypotension not responding to initial fluid resuscitation to maintain mean arterial pressure (MAP) > 65 mm Hg 5. In the event of persistent hypotension despite fluid resuscitation (septic shock) and/or lactate > 4mmol/L ◦ a. Achieve a central venous pressure (CVP) of > 8 mm Hg ◦ b. Achieve a central venous oxygen saturation (ScvO2) > 70 % or mixed venous oxygen saturation (SvO2) > 65 % (Surviving Sepsis Campaign)
  17. 17.  Efforts to accomplish these goals should begin immediately, but these items may be completed within 24 hours of presentation for patients with severe sepsis or septic shock. 1. Administer low-dose steroids for septic shock in accordance with a standardized ICU policy. If not administered, document why the patient did not qualify for low-dose steroids based upon the standardized protocol.
  18. 18.  2. Administer drotrecogin alfa (activated) in accordance with a standardized ICU policy. If not administered, document why the patient did not qualify for drotrecogin alfa (activated). 3. Maintain glucose control > 70, but < 150 mg/dl 4. Maintain a median inspiratory plateau pressure (IPP)* < 30 cm H2O for mechanically ventilated patients
  19. 19.  Apache II Score Measure Serum Lactate Levels Blood cultures Initiate IV Antibiotic Therapy Treatment of Hypotension Keep oxygen saturation stable/Ventilator
  20. 20.  Broad Spectrum Antibiotics should be administered within 3 hours of suspected Severe Sepsis or Septic Shock Blood cultures need to be drawn before antibiotics are started
  21. 21.  Treat Hypotension If presenting with hypotension and/or lactate level of >4 mmol/L give 20mL/kg of crystalloid solution ◦ Lactated Ringer’s ◦ Normal saline Fluid administration to reach a CVP of >8mm Hg
  22. 22.  When patients do not respond to initial fluid resuscitation, use vasopressor therapy to maintain a MAP > 65mm Hg ◦ Dopamine ◦ Norepinephrine ◦ Titrate according to protocol
  23. 23.  Blood cultures should be re-evaluated in 48 hours to determine specific antibiotic therapy Continue monitoring patient’s vital signs till hemodynamically stable Follow protocols for PICC dressing, hand washing, dressing changes, and peri care
  24. 24.  http://www.survivingsepsis.org/What_You_Should_Kn ow/Pages/default.aspx http://www.nigms.nih.gov/Education/factsheet_sepsis.h tm http://www.merckmanuals.com/professional/critical_ca re_medicine/sepsis_and_septic_shock/sepsis_and_septi c_shock.html http://www.merckmanuals.com/home/infections/bacter emia_sepsis_and_septic_shock/sepsis_and_septic_shoc k.html
  25. 25.  http://www.survivingsepsis.org/SiteCollectionDocumen ts/Pathophysiology%20of%20Sepsis%20Phil(2).pdf Surviving Sepsis Campaign, 2010 Dellinger, P., Levy, M., Carlet, J., Bion, J., Parker, M., Jaeschke, R.,et al (2008). Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock. Critical Care Medicine, 1-33, DOI: 10.1097/01.CCM.0000298158.12101.41.
  26. 26.  Wesley, E., Kleinpell, R., Goyette, R., (2003). Advances in the understanding of clinical manifestations and therapy of severe sepsis: An update for critical care nurses. American Journal of Critical Care, 12(2),120-133. Retrieved from http://ajcc.aacnjournals.org/content/12/2/1 20.full
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