STOP Sepsis<br />6-hour <br />Strategies to <br />Timely <br />Obviate the <br />Progression of Sepsis<br />6-hour STOP Bu...
Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock<br />Rivers E.  N Engl J Med 2001;345:1368-...
Sepsis<br />SIRS<br />Severe Sepsis<br />Septic Shock<br />Sepsis<br />SIRS<br />Severe Sepsis<br />Septic Shock<br />Syst...
HR > 90
RR > 20 or PCO2 < 32
WBC < 4K or > 12K or bands > 10%</li></ul>Bone et al. Chest 1992;101:1644<br />
SIRS<br />Severe Sepsis<br />Septic Shock<br />Sepsis<br />SIRS with Infection<br />Bone et al. Chest 1992;101:1644<br />
SIRS<br />Severe Sepsis<br />Septic Shock<br />Sepsis<br />Sepsis plus Organ Dysfunction<br /><ul><li>Elevated Creatinine ...
Elevated INR (DIC)
Altered Mental Status (GCS <12)
Elevated Lactate (>4)
Hypotension that responds to fluid</li></ul>Bone et al. Chest 1992;101:1644<br />
SIRS<br />Severe Sepsis<br />Septic Shock<br />Sepsis<br />Severe Sepsis and Hypotension<br /><ul><li>Hypotension that doe...
Criteria to initiate the bundle<br />SIRS plus source of infection plus a<br /><ul><li>SBP < 90 mmHg after a 20 mL/kg flui...
Lactate > 4 mmol/L
Organ dysfunction</li></ul>STOP<br />SEPSIS<br />SCCM 34th Critical Care Congress: Abstract 44. Presented Jan. 17,2005.<br />
STOP Bundle Strategies<br /><ul><li>Hemodynamic monitoring (CVP/ScvO2) within 2 hours
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The STOP Sepsis Bundle

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The STOP Sepsis Bundle Toolkit
Strategies to Timely Obviate the Progression of Sepsis in the Emergency Department

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The STOP Sepsis Bundle

  1. 1. STOP Sepsis<br />6-hour <br />Strategies to <br />Timely <br />Obviate the <br />Progression of Sepsis<br />6-hour STOP Bundle<br />summarized by sun yaicheng http://decode-medicine.blogspot.com/<br />
  2. 2. Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock<br />Rivers E. N Engl J Med 2001;345:1368-77.<br />
  3. 3.
  4. 4.
  5. 5.
  6. 6. Sepsis<br />SIRS<br />Severe Sepsis<br />Septic Shock<br />Sepsis<br />SIRS<br />Severe Sepsis<br />Septic Shock<br />Systemic Inflammatory Response Syndrome <br /><ul><li>Temp < 36 ° C or > 38.3 ° C
  7. 7. HR > 90
  8. 8. RR > 20 or PCO2 < 32
  9. 9. WBC < 4K or > 12K or bands > 10%</li></ul>Bone et al. Chest 1992;101:1644<br />
  10. 10. SIRS<br />Severe Sepsis<br />Septic Shock<br />Sepsis<br />SIRS with Infection<br />Bone et al. Chest 1992;101:1644<br />
  11. 11. SIRS<br />Severe Sepsis<br />Septic Shock<br />Sepsis<br />Sepsis plus Organ Dysfunction<br /><ul><li>Elevated Creatinine (>2)
  12. 12. Elevated INR (DIC)
  13. 13. Altered Mental Status (GCS <12)
  14. 14. Elevated Lactate (>4)
  15. 15. Hypotension that responds to fluid</li></ul>Bone et al. Chest 1992;101:1644<br />
  16. 16. SIRS<br />Severe Sepsis<br />Septic Shock<br />Sepsis<br />Severe Sepsis and Hypotension<br /><ul><li>Hypotension that does NOT respond to fluid (500 cc bolus)</li></ul>Bone et al. Chest 1992;101:1644<br />
  17. 17. Criteria to initiate the bundle<br />SIRS plus source of infection plus a<br /><ul><li>SBP < 90 mmHg after a 20 mL/kg fluid bolus
  18. 18. Lactate > 4 mmol/L
  19. 19. Organ dysfunction</li></ul>STOP<br />SEPSIS<br />SCCM 34th Critical Care Congress: Abstract 44. Presented Jan. 17,2005.<br />
  20. 20. STOP Bundle Strategies<br /><ul><li>Hemodynamic monitoring (CVP/ScvO2) within 2 hours
  21. 21. Broad spectrum antibiotics administered within 4 hours
  22. 22. EGDT achieved at 6 hours, including CVP ≧ 8 mmHg, MAP ≧65 mmHg, ScvO2≧70%
  23. 23. Monitor for decreasing lactate; and administer steroid if on a vasopressor</li></li></ul><li>
  24. 24.
  25. 25.
  26. 26.
  27. 27.
  28. 28. Fever, general malaise, poor appetite for days<br />DM, HTN<br />70/40 mmHg, 39 ° C<br />
  29. 29.
  30. 30. Diagnosis<br />Liver Abscess with Septic Shock <br />Next ?<br />
  31. 31. What‘s the key point ?<br />summarized by sun yaicheng<br />http://decode-medicine.blogspot.com/<br />
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