practical sepsis management according to latest guidelines

1. DR.RAZIMAN BIN ABDUL RAZAK
ANESTESIOLOGY & INTENSIVE CARE DEPARTMENT
HOSPITAL AMPANG

3. ANTIBIOTICS & SOURCE CONTROL
FLUID +- BLOOD
VASOPRESSOR/ INOTROPES
?STEROID

6. 1. CVP
2. ScVO2
3. MAP
4. URINE OUTPUT
1. FLUIDS
2. INOTROPES & BLOOD
3. VASOPRESSOR
4. ORGAN IMPAIRMENT/
SEVERITY

8. 6 HOURS 12 HOURS/ 24 HOURS
1. FLUIDS
2. ANTIBIOTI
C
1. VASOPRESSOR
2. SOURCE CONTROL

9. 3 HOURS 6 HOURS
1. FLUIDS
2. ANTIBIOTI
C
1. VASOPRESSOR

10. 1. CVP
2. ScVO2
3. MAP
4. URINE OUTPUT
5. LACTATE LEVEL
1. FLUIDS
2. INOTROPES &
BLOOD
3. VASOPRESSOR
4. ORGAN
IMPAIRMENT/
SEVERITY

12. INTRODUCTION
HISTORY OF SCC
GUIDELINES SCC 2016, REVISION 2018
APPLICATION OF THE GUIDELINES
CASE DISCUSSION
Q&A, DISCUSSION
POINT TO PONDER

13. • DIAGNOSIS/
DEFINITION
• MANAGEMENT

14. “life threatening organ dysfunction caused by a
dysregulated host response to infection”
•Infection: the invasion of normally sterile tissue by
organisms resulting in infectious pathology
•Organ Dysfunction: Increase of 2 or more points in
SOFA Score (Sepsis-related/Sequential Organ Failure
Assessment)

20. 3 HOURS 6 HOURS
1. FLUIDS
2. ANTIBIOTI
C
1. VASOPRESSOR

23. 1. CVP
2. ScVO2
3. MAP
4. URINE OUTPUT
5. LACTATE LEVEL
1. FLUIDS
2. INOTROPES &
BLOOD
3. VASOPRESSOR
4. ORGAN
IMPAIRMENT/
SEVERITY

24. 1. CVP
2. ScVO2
3. MAP
4. URINE OUTPUT
5. LACTATE LEVEL
1. ?FLUIDS
2. ?INOTROPES &
BLOOD
3. VASOPRESSOR
4. ORGAN
IMPAIRMENT/
SEVERITY

26. 37 Y FEMALE, NKMI, WT 70KG
PREGNANT 18WK, DIAGNOSED AS INEVITABLE
ABORTION
D6 IN WARD DEVELOPED SEPSIS
DIAGNOSIS- SIRS, SOFA SCORE, q SOFA
CLASSIFY SEVERITY
GOALS- MAP, LACTATE LEVEL
TREATMENT (BUNDLES)
FLUID
VASOPRESSOR
ANTIBIOTIC
?SOURCE CONTROL

29. DIAGNOSIS: INFECTION + > 2 SOFA SCORE
CLASSIFICATION: INFECTION, SEPSIS, SEPTIC
SHOCK
MANAGEMENT:
 3HRS BUNDLE
 AT LEAST 30MLS/KG CRYSTALLOID
 VASOPRESSOR: NORADRENALINE AS A 1ST CHOICE
 BROADSPECTRUM ANTIBIOTIC
 HR 1 BUNDLE (2018)
 GOALS: MAP>65 MMHG, LACTATE LEVEL < 4MMMOL/L
 OTHERS: STEROID, GLUCOSE CONTROL, VENTILATOR,