This document describes the case of a 63-year-old female who was found collapsed at home and exhibited signs of acute confusion and sepsis. Initial observations found her to have a low blood pressure, fast heart rate, and altered mental status. Her history included a recent UTI and various medical conditions. Investigations showed signs of infection and organ dysfunction. She received IV fluids, antibiotics, and was transferred to the ICU for management of septic shock based on the Surviving Sepsis Campaign guidelines. The guidelines aim to standardize sepsis care through bundles for early resuscitation and management to reduce mortality from this leading cause of ICU admissions and deaths. Barriers to compliance include a lack of recognition, time constraints, and need
2. 63year old female
●PC Collapse/Generally Unwell
Acute Confusion
●HPC Found collapsed on bathroom floor
● by neighbour/carer
● Not sure how long
● Lives alone
Behaving confused, unable to stand unaided
13. Surviving Sepsis Campaign
● Sepsis Management Bundle
– 24 hours
– Steroids
– Recombinant Activated Protein C
– Glucose control
– Insp plateau pressure <30cm H20
14. Surviving Sepsis Campaign
● Implementation difficulties
– Lack of recognition
– Time and staffing
– Need for specialised equipment and training
– Lack of quality assurance measures
– Lack of collaboration between specialities
15. Surviving Sepsis Campaign
● How to improve compliance
– Education Interventions
– Tools and Quality indicators
– Collaboration
– Sepsis preparation and organisation
– Feedback
Editor's Notes
FIONN HAS ASKED ME TO SAY ALITTLE WORD ABOUT SEPSIS AND THECHALLENGES THAT WE AS A DEPARTMENT HAVE WITH IMPLEMENTING THE CURRENT GUIDELINES
AS AN ILLUSTRATION I HAVE A CASE PRESENTATION AND it is A CASE ABOUT WHICH I GATHER THERE HAS BEEN SOME DISCUSSION WITH ICU REGARDING THE ISSUES
Ambulance,
Origin 13.33
At scene 1342
Leftscene 15 39
At hosp 1555
Obs1610
IV nsaline 1000mls 16.10
ABGS 16.34
Urinary catheter 16.50
Ab therapy 1710 – 15
1v saline 1000mls 17.30
ITU 18.40;
BIBA FOUND BY HER NEIGHBOUT COLLAPSED IN THE BATHROOM, HAVING VOMITED AND BEHAVING CONFUSED, NOT SURE HOW LONG SHEHAD BEEN THERE. SHE LIVED ALONE BUT HAD BEEN SEEN THE DAY BEFORE
ABULANCE SHEET SAID CONFUSED, NOT VOCALISING UNABLE TO STAND UNAIDED CONFUSED MOVEMENT
THOUGHTS ON THE DIFFERENTIAL
MY THOUGHTS WERE
DIABETIC
COULDNT IGNORE UTI
FIONN
NOTE TAKING
I WILL BE THE FIRST ONE TOADMIT THAT MY NOTE TAKING IN THIS CASE WAS RATHER LACKING
TIMES
ADMISSION
REFERRAL
FIONN
NOTE TAKING
I WILL BE THE FIRST ONE TOADMIT THAT MY NOTE TAKING IN THIS CASE WAS RATHER LACKING
TIMES
ADMISSION
REFERRAL
Although se[sis affects young and old extent is on the increase because of increased elderly pop , interventionz, antibiotic therapy
18million cases world wide
Leading death in non coronaryicu
Mortality very high
International collaboration of european soc of icm, socoety of critical care medicine 100 countries and international sepsis forum
Awareness, diagnosis,appropriate treatments and interventions, education
Guidelines are systematic statements designed to assist doctors in diagnostic and therapeutic decision making
Objective representation of how drs believe care should be given
Instutute if healthcare improvement
Database centered change measurement process
Bundles A "bundle" is a group of therapies for a given disease that, when implemented together, may result in better outcomes than if implemented individually. In a bundle, the individual elements included are built around best evidence-based practices. The science supporting the individual treatment strategies in a bundle is sufficiently mature such that implementation of the approach should be considered either best practice or a reasonable and generally accepted practice.
· ··Systemic inflammatory response syndrome (SIRS). Defined by the presence of two or more of the following findings:
· ··Body temperature < 36 °C (97 °F) or > 38 °C (100 °F) (··hypothermia or ··fever).
· ··Heart rate > 90 beats per minute.
· ··Respiratory rate > 20 breaths per minute or, on ··blood gas, a PaCO2 less than 32 ··mm Hg (4.3 ··kPa) (··tachypnea or ··hypocapnia due to ··hyperventilation).
· ··White blood cell count < 4,000 cells/··mm3 or > 12,000 cells/mm3 (< 4 × 109 or > 12 × 109 cells/··L), or greater than 10% band forms (immature white blood cells). (··leukopenia, ··leukocytosis, or ··bandemia).
· Sepsis. Defined as SIRS in response to a confirmed infectious process. Infection can be suspected or proven (by culture, stain, or ··polymerase chain reaction (PCR)), or a clinical syndrome pathognomonic for infection. Specific evidence for infection includes WBCs in normally sterile fluid (such as urine or ··cerebrospinal fluid (CSF)); evidence of a perforated ··viscus (free air on abdominal x-ray or CT scan; signs of ··acute peritonitis); abnormal chest x-ray (CXR) consistent with ··pneumonia (with focal opacification); or ··petechiae, ··purpura, or ··purpura fulminans.
· Severe sepsis. Defined as sepsis with organ dysfunction, hypoperfusion, or hypotension.
· ··Septic shock. Defined as sepsis with refractory arterial ··hypotension or hypoperfusion abnormalities in spite of adequate fluid resuscitation. Signs of systemic ··hypoperfusion may be either end-organ dysfunction or serum lactate greater than 4 mmol/L. Other signs include ··oliguria and ··altered mental status. Patients are defined as having ··septic shock if they have sepsis plus hypotension after aggressive fluid resuscitation (typically upwards of 6 liters or 40 ml/kg of ··crystalloid solution).
Antibiotics within 3 hours of edadmission and 1 hour or icu admission
Abtherapy must be aprropriate > prompt
48 hour reevaluation
If hypotensive orlactate > 4 give 20ml/kg bolus fluids or vasopressors to get amap >65
Antibiotics within 3 hours of edadmission and 1 hour or icu admission
Abtherapy must be aprropriate > prompt
48 hour reevaluation
If hypotensive orlactate > 4 give 20ml/kg bolus fluids or vasopressors to get amap >65
Inconsistency in the early diagnosis of severe sepsis and septic shock 2. Frequent inadequate volume resuscitation without defined endpoints3. Late or inadequate use of antibiotics 4. Frequent failure to support the cardiac output when depressed5. Frequent failure to control hyperglycemia adequately 6. Frequent failure to use low tidal volumes and pressures in acute lung injury 7. Frequent failure to treat adrenal inadequacy in refractory shock
Theseare often multifactorial and include group education, the use
of the Institute for Healthcare Improvement toolkits to aid with
incorporation of recommendations, close collaboration with
other medical specialties such as critical care, standardized
order sets, and collecting feedback