- This document summarizes guidelines from the Surviving Sepsis Campaign for the management of severe sepsis and septic shock.
- The guidelines recommend beginning resuscitation immediately for patients with hypotension or elevated lactate, obtaining cultures before antibiotics, administering broad-spectrum antibiotics within 1 hour, and controlling blood glucose with insulin.
- For patients requiring vasopressors, the guidelines suggest considering vasopressin, dobutamine, or hydrocortisone therapy and treating with recombinant human activated protein C for certain high-risk patients.
This document provides an overview of sepsis and septic shock. It defines the clinical syndromes related to sepsis including systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock. It outlines the goals of treating septic shock which include initial fluid resuscitation, stabilizing hemodynamics with pressors, administering antibiotics, and interrupting inflammatory mediators. It discusses early goal directed therapy for septic shock patients, which aims to achieve specific goals regarding central venous pressure, mean arterial pressure, and central venous oxygen saturation within the first 6 hours in order to decrease mortality.
This document discusses shock, sepsis management, and fluid resuscitation. It addresses:
1) Types of shock including hypovolemic, distributive, obstructive, cardiogenic, and neurogenic.
2) Principles of fluid resuscitation including increasing preload to improve stroke volume and cardiac output. However, fluid boluses only improve cardiac output in about 50% of ICU patients.
3) Dynamic measures like pulse pressure variation, stroke volume variation, passive leg raise, and echocardiography changes after fluid bolus are better than static measures at predicting fluid responsiveness.
The document discusses sepsis treatment bundles which include early goal directed therapy, corticosteroids, antibiotics, ARDSnet ventilator management, stress ulcer prophylaxis, deep vein thrombosis prophylaxis, and Drotrecogin alpha. It provides details on the components, goals, and guidelines for each bundle element aimed at improving outcomes for patients with sepsis.
1. The document outlines new definitions and guidelines for diagnosing and managing sepsis and septic shock according to the Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.
2. Key changes include removing SIRS criteria and defining sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock requires vasopressors to maintain blood pressure and elevated lactate levels.
3. Management guidelines cover initial patient assessment, diagnostic testing, antimicrobial therapy, fluid resuscitation, vasopressors, corticosteroids, mechanical ventilation, glucose control, nutrition, and thromboembolism prophylaxis
This document provides guidelines for the use of vasoactive medications in the treatment of sepsis and septic shock. It recommends norepinephrine as the first-choice vasopressor. It suggests adding vasopressin or epinephrine to norepinephrine to raise blood pressure targets or lower norepinephrine dosage. Dopamine should only be used in select patients due to risks of arrhythmias. Low-dose dopamine is not recommended for renal protection. Dobutamine may be used for persistent hypoperfusion despite fluids and vasopressors. The document also provides details on the use, effects, and guidelines for various vasoactive drugs to treat septic shock.
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is a subset of sepsis with profound circulatory and cellular abnormalities and increased mortality. The new definitions of sepsis and septic shock aim to improve early recognition and management. The one hour sepsis bundle outlines initial resuscitation goals including administering antibiotics and fluids, obtaining cultures, measuring lactate, and assessing for a source of infection within the first hour of recognition. Proper management of sepsis requires a multifaceted approach including source control, infection prevention strategies, organ support, and consideration of goals of care.
This document discusses the diagnosis and management of catastrophic antiphospholipid syndrome (CAPS). It notes that CAPS is a rare condition requiring a high level of suspicion. The key diagnostic criteria include involvement of three organs systems within one week and confirmation of antiphospholipid antibodies. Treatment involves giving corticosteroids and IVIG to rapidly raise platelet counts to a safe level for anticoagulation. Management also requires multidisciplinary care including plasma exchange, ICU support, immunosuppression, and avoiding platelet transfusions. The prognosis remains serious despite aggressive treatment.
This document provides an overview of sepsis and septic shock. It defines the clinical syndromes related to sepsis including systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock. It outlines the goals of treating septic shock which include initial fluid resuscitation, stabilizing hemodynamics with pressors, administering antibiotics, and interrupting inflammatory mediators. It discusses early goal directed therapy for septic shock patients, which aims to achieve specific goals regarding central venous pressure, mean arterial pressure, and central venous oxygen saturation within the first 6 hours in order to decrease mortality.
This document discusses shock, sepsis management, and fluid resuscitation. It addresses:
1) Types of shock including hypovolemic, distributive, obstructive, cardiogenic, and neurogenic.
2) Principles of fluid resuscitation including increasing preload to improve stroke volume and cardiac output. However, fluid boluses only improve cardiac output in about 50% of ICU patients.
3) Dynamic measures like pulse pressure variation, stroke volume variation, passive leg raise, and echocardiography changes after fluid bolus are better than static measures at predicting fluid responsiveness.
The document discusses sepsis treatment bundles which include early goal directed therapy, corticosteroids, antibiotics, ARDSnet ventilator management, stress ulcer prophylaxis, deep vein thrombosis prophylaxis, and Drotrecogin alpha. It provides details on the components, goals, and guidelines for each bundle element aimed at improving outcomes for patients with sepsis.
1. The document outlines new definitions and guidelines for diagnosing and managing sepsis and septic shock according to the Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.
2. Key changes include removing SIRS criteria and defining sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock requires vasopressors to maintain blood pressure and elevated lactate levels.
3. Management guidelines cover initial patient assessment, diagnostic testing, antimicrobial therapy, fluid resuscitation, vasopressors, corticosteroids, mechanical ventilation, glucose control, nutrition, and thromboembolism prophylaxis
This document provides guidelines for the use of vasoactive medications in the treatment of sepsis and septic shock. It recommends norepinephrine as the first-choice vasopressor. It suggests adding vasopressin or epinephrine to norepinephrine to raise blood pressure targets or lower norepinephrine dosage. Dopamine should only be used in select patients due to risks of arrhythmias. Low-dose dopamine is not recommended for renal protection. Dobutamine may be used for persistent hypoperfusion despite fluids and vasopressors. The document also provides details on the use, effects, and guidelines for various vasoactive drugs to treat septic shock.
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is a subset of sepsis with profound circulatory and cellular abnormalities and increased mortality. The new definitions of sepsis and septic shock aim to improve early recognition and management. The one hour sepsis bundle outlines initial resuscitation goals including administering antibiotics and fluids, obtaining cultures, measuring lactate, and assessing for a source of infection within the first hour of recognition. Proper management of sepsis requires a multifaceted approach including source control, infection prevention strategies, organ support, and consideration of goals of care.
This document discusses the diagnosis and management of catastrophic antiphospholipid syndrome (CAPS). It notes that CAPS is a rare condition requiring a high level of suspicion. The key diagnostic criteria include involvement of three organs systems within one week and confirmation of antiphospholipid antibodies. Treatment involves giving corticosteroids and IVIG to rapidly raise platelet counts to a safe level for anticoagulation. Management also requires multidisciplinary care including plasma exchange, ICU support, immunosuppression, and avoiding platelet transfusions. The prognosis remains serious despite aggressive treatment.
The document summarizes guidelines for managing severe sepsis and septic shock according to bundles of care elements that should be completed within specific timeframes. The bundles include a sepsis resuscitation bundle with elements that should be completed within 6 hours, and a sepsis management bundle with elements that should be completed within 24 hours. Both bundles are aimed at reducing mortality from sepsis through early intervention and treatment.
A Review On Hematology and Oncology EmergenciesChew Keng Sheng
This document provides information on blood products and their indications for transfusion, including:
- Packed red blood cells are generally indicated when hemoglobin is less than 10g/dL and almost always below 6g/dL. They increase hemoglobin by about 1g/dL per unit.
- Fresh frozen plasma contains clotting factors and is used to treat clotting factor deficiencies or massive bleeding requiring transfusion of over 5 units of packed red cells.
- Platelets are used to treat thrombocytopenia, with thresholds for transfusion depending on risk of bleeding. One unit raises platelet count by 5,000-10,000 cells/mm3.
- Complications of transfusion include allergic
This document discusses C-reactive protein (CRP) and its role in myocardial infarction. CRP is an acute phase protein that increases during inflammation and is a marker of tissue damage. Elevated CRP is associated with a higher risk of cardiovascular events like myocardial infarction. The document outlines several methods for measuring CRP concentration, with ELISA and immunofluorescence being more sensitive techniques. It establishes CRP levels that correspond to low, moderate, and high risk of cardiovascular problems. CRP is presented as a useful prognostic indicator for myocardial infarction and inflammation's role in atherosclerosis.
This document discusses relative adrenal insufficiency, a condition where the adrenal glands do not adequately increase cortisol production during physiological stress such as sepsis. It defines relative adrenal insufficiency and explains that testing for it can be unreliable. For patients in sepsis who require vasopressors, the document recommends having a low threshold to treat with hydrocortisone but not fludrocortisone, as it has not been shown to help. The case presented is of a man in sepsis, and the recommended next step is to administer hydrocortisone.
The document discusses the approach to traumatic shock. It details the pathophysiology of hemorrhagic shock, which leads to impaired oxygen delivery and hypoperfusion. The clinical features and diagnosis are variable depending on the cause, rate, and duration of blood loss. Treatment priorities include restoring intravascular volume, maintaining oxygen-carrying capacity, limiting ongoing blood loss, preventing coagulopathy and hypothermia. Massive transfusion protocols aim to replace lost blood with balanced ratios of packed red blood cells, plasma, and platelets to improve outcomes.
Three sentences:
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Mortality from sepsis is high, ranging from 30-60% depending on the presence of septic shock. New guidelines in 2016 defined sepsis as a life-threatening organ dysfunction represented by a SOFA score increase of 2 or more points from the patient's baseline.
The 2016 guidelines for management of sepsis and septic shock provide updated definitions and recommendations. Key changes include removal of SIRS criteria and introduction of quick SOFA (qSOFA) to identify high risk patients. The guidelines emphasize early recognition and treatment of sepsis as a medical emergency, with initiation of broad-spectrum antibiotics and fluid resuscitation within 1 hour. They provide recommendations on appropriate fluid choice, vasopressor use, and de-escalation of care once the patient shows signs of improvement.
Septic shock is a life-threatening condition that arises when sepsis leads to dangerously low blood pressure and problems in organ function. It results from an infection that causes changes throughout the body. Early recognition and treatment are important, including administering antibiotics within an hour, aggressive fluid resuscitation, and monitoring for organ dysfunction. Goals of management are restoring blood pressure, reversing signs of low perfusion, and treating the underlying infection while avoiding additional organ injury.
This document describes the case of a 4-year-old girl admitted to the hospital for sepsis. Upon admission, she had a high heart rate, low blood pressure, prolonged capillary refill time, and low oxygen saturation. She received fluid resuscitation and vasopressor support. Her condition required treatment in the intensive care unit with additional monitoring, intravenous antibiotics and other supportive care measures outlined in the document.
The document discusses sepsis and the importance of early recognition and treatment. It outlines the sepsis screening criteria and bundles that should be implemented, including lactate measurement, IV fluids, antibiotics within 1 hour, and hemodynamic monitoring to guide resuscitation. The 3-hour and 6-hour bundles are aimed at rapid restoration of tissue perfusion and prevention of organ dysfunction to reduce mortality in patients with severe sepsis or septic shock. Early goal-directed therapy and completion of bundles within time targets are emphasized.
This document provides information on sepsis for EMS providers, including causes and risk factors, signs and symptoms, treatment guidelines, and case studies. Sepsis is a serious condition that can lead to septic shock and organ failure if not treated quickly. The guidelines describe identifying septic patients in the field using specific criteria and initiating fluid resuscitation and transport to the hospital for early goal directed therapy to improve outcomes. Case studies demonstrate application of the guidelines and emphasize importance of early recognition and treatment.
This document provides guidelines for the management of severe sepsis and septic shock according to the Surviving Sepsis Campaign. It outlines the initial resuscitation goals of fluid resuscitation, antibiotic administration, lactate clearance, and maintaining a central venous oxygen saturation of greater than 70% through fluid administration, vasopressors if needed, and dobutamine. The use of stress-dose steroids and recombinant human activated protein C for certain high-risk patients is also recommended.
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection.The definition of sepsis was updated in 2016 following publication of the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). This recommended that organ dysfunction should be defined using the Sequential (or Sepsis-related) Organ Failure Assessment (SOFA) criteria or the "quick" (q)SOFA criteria.
The document provides guidelines for the management of severe sepsis and septic shock from the Surviving Sepsis Campaign. It outlines recommendations for initial resuscitation goals, fluid therapy, vasopressors, inotropes, steroids, blood products, mechanical ventilation, sedation, glucose control, renal replacement, bicarbonate therapy, deep vein thrombosis prophylaxis, and stress ulcer prophylaxis. The guidelines are aimed at optimizing hemodynamics, oxygen delivery, and organ function for patients with sepsis and septic shock.
This document discusses the approach to cardiac failure. It begins with a case study of a 24-year-old male presenting with shortness of breath and fever. Initial assessments found reduced heart function and the patient was intubated. The document then covers diagnostic assessments including ECG, chest x-ray, troponin, and echocardiogram. It discusses types of cardiac failure including forward and backward failure. Management strategies are outlined such as reducing demand on the heart, increasing cardiac supply, and long-term therapies including ACE inhibitors and beta blockers. Specific conditions like cardiogenic shock and right heart failure are also addressed.
1) Shock is defined as inadequate tissue perfusion resulting from low blood pressure and abnormal cellular metabolism. The main types of shock are hypovolemic, distributive, and cardiogenic.
2) Hypovolemic shock occurs when intravascular volume is decreased, such as from blood loss, and requires fluid resuscitation. Septic shock, a form of distributive shock, involves infection and organ dysfunction and responds to antibiotics, fluids, and vasopressors.
3) Cardiogenic shock results from heart failure or damage and may be caused by myocardial infarction. It requires hemodynamic support through medications like dopamine or norepinephrine while the underlying cardiac issue is addressed.
This document summarizes the 2016 guidelines from the Surviving Sepsis Campaign for the management of severe sepsis and septic shock. It outlines recommendations for initial resuscitation with IV fluids, vasopressors, corticosteroids, antibiotics, source control, blood products, glucose control, and bicarbonate therapy. The guidelines emphasize early recognition and treatment, with IV fluids, broad-spectrum antibiotics within 1 hour, and measuring lactate and targeting MAP of 65 mmHg as priorities in initial resuscitation of sepsis and septic shock.
1. Relative adrenal insufficiency is common in ICU patients with septic shock, but its clinical importance remains controversial. There is no agreed upon standard for diagnosing it, and uncertainty about treatment response.
2. ICU patients with septic shock whose blood pressure does not respond to fluid boluses and vasopressors should receive stress-dose steroids like hydrocortisone, though guidelines are based on limited evidence given mixed study results.
3. Critically ill ICU patients who recently received long-term steroids equivalent to 25 mg prednisone daily for over 7 days may need stress-dose steroid coverage due to risk of adrenal insufficiency.
This document provides guidelines for the management of severe sepsis and septic shock according to the Surviving Sepsis Campaign. It outlines diagnostic criteria for sepsis, septic shock, and organ dysfunction. It also details bundles of care that should be completed within 3 and 6 hours of diagnosis, including measuring lactate levels, administering antibiotics and fluids, and applying vasopressors if needed. The guidelines provide recommendations on initial resuscitation, antibiotic therapy, source control, infection prevention, fluid therapy, vasopressors, corticosteroids, mechanical ventilation, and other supportive care measures for managing sepsis.
1. Sepsis is a major cause of morbidity and mortality worldwide, with mortality rates ranging from 15-60% depending on the severity. The guidelines provide recommendations for the management of sepsis, severe sepsis, and septic shock.
2. The initial focus is on early recognition and treatment within the first hour including antibiotics, fluid resuscitation, lactate monitoring, and source control. Vasopressors, inotropes, steroids and other supportive care measures are also addressed.
3. Goals are to diagnose and treat the infection while restoring tissue perfusion and organ function through a coordinated response and supportive therapies.
The document summarizes guidelines for managing severe sepsis and septic shock according to bundles of care elements that should be completed within specific timeframes. The bundles include a sepsis resuscitation bundle with elements that should be completed within 6 hours, and a sepsis management bundle with elements that should be completed within 24 hours. Both bundles are aimed at reducing mortality from sepsis through early intervention and treatment.
A Review On Hematology and Oncology EmergenciesChew Keng Sheng
This document provides information on blood products and their indications for transfusion, including:
- Packed red blood cells are generally indicated when hemoglobin is less than 10g/dL and almost always below 6g/dL. They increase hemoglobin by about 1g/dL per unit.
- Fresh frozen plasma contains clotting factors and is used to treat clotting factor deficiencies or massive bleeding requiring transfusion of over 5 units of packed red cells.
- Platelets are used to treat thrombocytopenia, with thresholds for transfusion depending on risk of bleeding. One unit raises platelet count by 5,000-10,000 cells/mm3.
- Complications of transfusion include allergic
This document discusses C-reactive protein (CRP) and its role in myocardial infarction. CRP is an acute phase protein that increases during inflammation and is a marker of tissue damage. Elevated CRP is associated with a higher risk of cardiovascular events like myocardial infarction. The document outlines several methods for measuring CRP concentration, with ELISA and immunofluorescence being more sensitive techniques. It establishes CRP levels that correspond to low, moderate, and high risk of cardiovascular problems. CRP is presented as a useful prognostic indicator for myocardial infarction and inflammation's role in atherosclerosis.
This document discusses relative adrenal insufficiency, a condition where the adrenal glands do not adequately increase cortisol production during physiological stress such as sepsis. It defines relative adrenal insufficiency and explains that testing for it can be unreliable. For patients in sepsis who require vasopressors, the document recommends having a low threshold to treat with hydrocortisone but not fludrocortisone, as it has not been shown to help. The case presented is of a man in sepsis, and the recommended next step is to administer hydrocortisone.
The document discusses the approach to traumatic shock. It details the pathophysiology of hemorrhagic shock, which leads to impaired oxygen delivery and hypoperfusion. The clinical features and diagnosis are variable depending on the cause, rate, and duration of blood loss. Treatment priorities include restoring intravascular volume, maintaining oxygen-carrying capacity, limiting ongoing blood loss, preventing coagulopathy and hypothermia. Massive transfusion protocols aim to replace lost blood with balanced ratios of packed red blood cells, plasma, and platelets to improve outcomes.
Three sentences:
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Mortality from sepsis is high, ranging from 30-60% depending on the presence of septic shock. New guidelines in 2016 defined sepsis as a life-threatening organ dysfunction represented by a SOFA score increase of 2 or more points from the patient's baseline.
The 2016 guidelines for management of sepsis and septic shock provide updated definitions and recommendations. Key changes include removal of SIRS criteria and introduction of quick SOFA (qSOFA) to identify high risk patients. The guidelines emphasize early recognition and treatment of sepsis as a medical emergency, with initiation of broad-spectrum antibiotics and fluid resuscitation within 1 hour. They provide recommendations on appropriate fluid choice, vasopressor use, and de-escalation of care once the patient shows signs of improvement.
Septic shock is a life-threatening condition that arises when sepsis leads to dangerously low blood pressure and problems in organ function. It results from an infection that causes changes throughout the body. Early recognition and treatment are important, including administering antibiotics within an hour, aggressive fluid resuscitation, and monitoring for organ dysfunction. Goals of management are restoring blood pressure, reversing signs of low perfusion, and treating the underlying infection while avoiding additional organ injury.
This document describes the case of a 4-year-old girl admitted to the hospital for sepsis. Upon admission, she had a high heart rate, low blood pressure, prolonged capillary refill time, and low oxygen saturation. She received fluid resuscitation and vasopressor support. Her condition required treatment in the intensive care unit with additional monitoring, intravenous antibiotics and other supportive care measures outlined in the document.
The document discusses sepsis and the importance of early recognition and treatment. It outlines the sepsis screening criteria and bundles that should be implemented, including lactate measurement, IV fluids, antibiotics within 1 hour, and hemodynamic monitoring to guide resuscitation. The 3-hour and 6-hour bundles are aimed at rapid restoration of tissue perfusion and prevention of organ dysfunction to reduce mortality in patients with severe sepsis or septic shock. Early goal-directed therapy and completion of bundles within time targets are emphasized.
This document provides information on sepsis for EMS providers, including causes and risk factors, signs and symptoms, treatment guidelines, and case studies. Sepsis is a serious condition that can lead to septic shock and organ failure if not treated quickly. The guidelines describe identifying septic patients in the field using specific criteria and initiating fluid resuscitation and transport to the hospital for early goal directed therapy to improve outcomes. Case studies demonstrate application of the guidelines and emphasize importance of early recognition and treatment.
This document provides guidelines for the management of severe sepsis and septic shock according to the Surviving Sepsis Campaign. It outlines the initial resuscitation goals of fluid resuscitation, antibiotic administration, lactate clearance, and maintaining a central venous oxygen saturation of greater than 70% through fluid administration, vasopressors if needed, and dobutamine. The use of stress-dose steroids and recombinant human activated protein C for certain high-risk patients is also recommended.
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection.The definition of sepsis was updated in 2016 following publication of the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). This recommended that organ dysfunction should be defined using the Sequential (or Sepsis-related) Organ Failure Assessment (SOFA) criteria or the "quick" (q)SOFA criteria.
The document provides guidelines for the management of severe sepsis and septic shock from the Surviving Sepsis Campaign. It outlines recommendations for initial resuscitation goals, fluid therapy, vasopressors, inotropes, steroids, blood products, mechanical ventilation, sedation, glucose control, renal replacement, bicarbonate therapy, deep vein thrombosis prophylaxis, and stress ulcer prophylaxis. The guidelines are aimed at optimizing hemodynamics, oxygen delivery, and organ function for patients with sepsis and septic shock.
This document discusses the approach to cardiac failure. It begins with a case study of a 24-year-old male presenting with shortness of breath and fever. Initial assessments found reduced heart function and the patient was intubated. The document then covers diagnostic assessments including ECG, chest x-ray, troponin, and echocardiogram. It discusses types of cardiac failure including forward and backward failure. Management strategies are outlined such as reducing demand on the heart, increasing cardiac supply, and long-term therapies including ACE inhibitors and beta blockers. Specific conditions like cardiogenic shock and right heart failure are also addressed.
1) Shock is defined as inadequate tissue perfusion resulting from low blood pressure and abnormal cellular metabolism. The main types of shock are hypovolemic, distributive, and cardiogenic.
2) Hypovolemic shock occurs when intravascular volume is decreased, such as from blood loss, and requires fluid resuscitation. Septic shock, a form of distributive shock, involves infection and organ dysfunction and responds to antibiotics, fluids, and vasopressors.
3) Cardiogenic shock results from heart failure or damage and may be caused by myocardial infarction. It requires hemodynamic support through medications like dopamine or norepinephrine while the underlying cardiac issue is addressed.
This document summarizes the 2016 guidelines from the Surviving Sepsis Campaign for the management of severe sepsis and septic shock. It outlines recommendations for initial resuscitation with IV fluids, vasopressors, corticosteroids, antibiotics, source control, blood products, glucose control, and bicarbonate therapy. The guidelines emphasize early recognition and treatment, with IV fluids, broad-spectrum antibiotics within 1 hour, and measuring lactate and targeting MAP of 65 mmHg as priorities in initial resuscitation of sepsis and septic shock.
1. Relative adrenal insufficiency is common in ICU patients with septic shock, but its clinical importance remains controversial. There is no agreed upon standard for diagnosing it, and uncertainty about treatment response.
2. ICU patients with septic shock whose blood pressure does not respond to fluid boluses and vasopressors should receive stress-dose steroids like hydrocortisone, though guidelines are based on limited evidence given mixed study results.
3. Critically ill ICU patients who recently received long-term steroids equivalent to 25 mg prednisone daily for over 7 days may need stress-dose steroid coverage due to risk of adrenal insufficiency.
This document provides guidelines for the management of severe sepsis and septic shock according to the Surviving Sepsis Campaign. It outlines diagnostic criteria for sepsis, septic shock, and organ dysfunction. It also details bundles of care that should be completed within 3 and 6 hours of diagnosis, including measuring lactate levels, administering antibiotics and fluids, and applying vasopressors if needed. The guidelines provide recommendations on initial resuscitation, antibiotic therapy, source control, infection prevention, fluid therapy, vasopressors, corticosteroids, mechanical ventilation, and other supportive care measures for managing sepsis.
1. Sepsis is a major cause of morbidity and mortality worldwide, with mortality rates ranging from 15-60% depending on the severity. The guidelines provide recommendations for the management of sepsis, severe sepsis, and septic shock.
2. The initial focus is on early recognition and treatment within the first hour including antibiotics, fluid resuscitation, lactate monitoring, and source control. Vasopressors, inotropes, steroids and other supportive care measures are also addressed.
3. Goals are to diagnose and treat the infection while restoring tissue perfusion and organ function through a coordinated response and supportive therapies.
Approach to Management of Fever & Sepsis (2) copy.pptxHarryArwin1
1) Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. It can be identified at the bedside using qSOFA, which is positive if a patient has at least two of respiratory rate above 22, altered mentation, or systolic blood pressure of 100 or less.
2) Initial management of sepsis involves administering antibiotics within 1 hour, giving IV fluids aggressively, and completing other resuscitation bundles like the Sepsis Six within 3 hours to support vital organ function.
3) Beyond initial resuscitation, source control, additional organ support, and adjustment of care based on clinical response are important for managing sepsis.
The document defines different types of acute coronary syndrome (ACS), including unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). It provides guidelines for the initial management and treatment of ACS, including medications, revascularization procedures, and timelines for invasive strategies depending on patient risk factors. The treatment guidelines are from organizations such as ACC/AHA, ESC, and Uptodate and aim to rapidly diagnose and treat ACS to reduce mortality.
The document provides an overview of the management of sepsis and septic shock. It discusses that early goal-directed therapy within the first 6 hours including antibiotics, fluids, vasopressors and inotropes if needed can significantly improve outcomes. Other key points covered include the definitions and diagnostic criteria for sepsis; appropriate antibiotic therapy and vasopressor use; importance of lung-protective ventilation; role for activated protein C, steroids, tight glucose control and renal replacement therapy. Prognosis depends on early recognition and treatment as mortality increases significantly with delayed or inadequate care.
This document defines septic shock and outlines its management. Septic shock is a subset of sepsis with circulatory or metabolic abnormalities and high mortality. It involves sepsis with hypotension requiring vasopressors or lactate above 2mmol/L despite fluid resuscitation. Causative organisms include bacteria and viruses. Risk factors include age extremes, immunosuppression, and invasive devices. Symptoms include low blood pressure, altered mental status, and respiratory distress. Complications affect the heart, lungs, kidneys, blood clotting, and brain. Treatment involves rapid antibiotic administration, fluid resuscitation, vasopressors, and corticosteroids if needed to restore blood pressure. Source control and supportive care are
1. Sepsis is defined as infection plus systemic manifestations of infection. Severe sepsis is sepsis plus organ dysfunction, while septic shock is sepsis-induced hypotension despite fluid resuscitation.
2. Initial management of septic shock includes administering broad-spectrum antibiotics within 1 hour, fluid resuscitation of at least 30 mL/kg of crystalloids, and vasopressors like norepinephrine to maintain a mean arterial pressure of 65 mmHg or higher.
3. Other recommended treatments include source control, glucose control with insulin to keep blood glucose under 180 mg/dL, stress ulcer prophylaxis as needed, and early enteral nutrition over total parenteral nutrition.
Traumatic brain injury (TBI) is a major public health problem in Egypt. The document outlines guidelines for the management of severe TBI based on the PROTECT III trial. It describes protocols for airway management, oxygenation, ventilation, blood pressure control, volume resuscitation, and intracranial pressure (ICP) monitoring. The guidelines provide a tiered approach for controlling ICP that includes head elevation, sedation, ventricular drainage, mannitol, hypertonic saline, barbiturates, and decompressive craniectomy. It also covers other aspects of care such as seizures prophylaxis, metabolic monitoring, surgery indications, and nutritional support.
The study randomized 1554 ICU patients with septic shock to either a restrictive or standard IV fluid therapy strategy. The restrictive group could only receive IV fluids if certain criteria for hypoperfusion were met, while the standard group had no limits. The primary outcome of death within 90 days was 42.3% in the restrictive group and 42.1% in the standard group, indicating no significant difference. Serious adverse events and other secondary outcomes were also similar between the two groups, suggesting that a restrictive IV fluid strategy for septic shock is not inferior to standard therapy.
Sepsis is a life-threatening organ dysfunction caused by a dysregulated response to infection. Early identification and treatment improves outcomes. The document outlines recommendations for screening and managing sepsis in three steps: 1) Screening and managing the initial infection. 2) Screening for organ dysfunction. 3) Identifying and managing initial hypotension. Key recommendations include administering broad-spectrum antibiotics within 1 hour, using lactate levels and qSOFA to identify organ dysfunction, giving 30mL/kg crystalloids for hypotension and lactate over 4mmol/L, and applying vasopressors like norepinephrine to maintain a MAP over 65mmHg.
ICU_vasopressors. infographic presenatation by one pageDr.Rakesh Reddy
This document provides guidance on treating vasopressor refractory shock. It recommends considering the underlying cause of shock and treating that directly rather than just increasing vasopressors. When vasopressors are needed, norepinephrine is often used first due to its combined vasoconstriction and inotropic effects. Phenylephrine, vasopressin, dopamine, and epinephrine are also discussed as options. The goal is to match the vasopressor to the patient's physiology and treat any acidosis or other underlying issues contributing to the shock.
This document outlines the diagnosis, screening, management, and treatment of sepsis and septic shock. It discusses initial investigations including labs and imaging that should be performed. It recommends goals for resuscitation including hemodynamic and lactate targets. It also outlines the priorities for immediate evaluation and management which include securing the airway, giving IV fluids and antibiotics within 1 hour, and starting vasopressors for refractory hypotension. Additional therapies discussed include glucocorticoids, inotropes, transfusion thresholds, nutrition, and VTE prophylaxis. Prognostic factors and post-discharge follow up are also summarized.
The document summarizes new guidelines for managing sepsis and septic shock published in 2016. Key points include:
- Sepsis is now defined as life-threatening organ dysfunction caused by infection. Septic shock involves circulatory and metabolic abnormalities with high mortality risk.
- Guidelines recommend early treatment including source control, broad-spectrum antibiotics within 1 hour, and at least 30mL/kg fluids for initial resuscitation to guide tissue perfusion.
- Ongoing resuscitation should be guided by frequent reassessment of hemodynamic status and lactate normalization when elevated. Vasopressors, steroids, and mechanical ventilation may be needed depending on individual patient circumstances.
- Performance improvement programs including sepsis screening are
Packed red blood cells (pRBCs) are used to treat acute blood loss and increase oxygen carrying capacity. Platelets are used when the platelet count is low to reduce the risk of bleeding. Fresh frozen plasma (FFP) contains coagulation factors and is used for bleeding due to multiple coagulation deficiencies. Cryoprecipitate contains high levels of factor VIII, von Willebrand factor, and fibrinogen and is used for von Willebrand disease and hemophilia A. Potential complications of blood transfusions include transmission of infections like hepatitis and HIV, allergic reactions, hemolytic reactions due to ABO incompatibility, alloimmunization, febrile non-hemolytic reactions, transfusion-related acute lung injury
Sepsis and septic shock result from a dysregulated host response to infection that leads to organ dysfunction. Management involves immediate resuscitation within 1 hour with IV fluids, antibiotics, and vasopressors if needed. Ongoing care includes source control, frequent reassessment of volume status, and supportive care such as mechanical ventilation and nutrition. The goals are to treat the underlying infection while supporting failing organs until the host response normalizes. Sepsis affects millions worldwide and requires swift treatment to prevent progression to septic shock and death.
This document provides guidelines for the management of severe sepsis and septic shock. It recommends beginning resuscitation immediately for patients with hypotension or elevated lactate and administering intravenous antibiotics within the first hour. Goals for resuscitation include a central venous pressure of 8-12 mmHg, mean arterial pressure of at least 65 mmHg, urine output of at least 0.5 mL/kg/hr, and central venous or mixed venous oxygen saturation of at least 70% or 65% respectively. A specific infection site should be established within 6 hours and source control measures implemented as soon as possible after initial resuscitation, with the exception of infected pancreatic necrosis.
SEPSIS AND SEPTIC SHOCK PRESENTATION.pptxmainhamza411
1) Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Diagnosis involves identifying infection and meeting criteria for systemic inflammatory response or organ dysfunction.
2) Management of sepsis involves early antibiotic therapy and source control, as well as fluid resuscitation, vasopressors if needed to maintain blood pressure, and inotropes for myocardial dysfunction.
3) Goals of initial resuscitation within 6 hours include central venous pressure of 8-12 mmHg, mean arterial pressure of at least 65 mmHg, urine output of 0.5 mL/kg/hr or more, and normalization of lactate if elevated.
The Surviving Sepsis Campaign was created in 2002 to reduce sepsis mortality through a 7 point agenda including developing guidelines, educating professionals, and improving diagnosis and ICU care. Sepsis is now defined as a life-threatening organ dysfunction caused by a dysregulated response to infection. Initial resuscitation goals include fluid resuscitation, vasopressors to maintain blood pressure and perfusion targets. Early, broad-spectrum antibiotics should begin within 1 hour along with blood cultures and source control. Other supportive therapies include mechanical ventilation, glucose control, DVT prophylaxis and early enteral nutrition.
This document provides guidelines for the management of severe sepsis and septic shock. It discusses definitions of sepsis, systemic inflammatory response syndrome, and septic shock. It outlines initial resuscitation goals including fluid resuscitation, vasopressors, inotropic therapy, and goals for central venous pressure, mean arterial pressure, urine output, and central venous or mixed venous oxygen saturation. It provides recommendations on antibiotic therapy, source control, steroids, activated protein C, transfusion thresholds, glucose control, renal replacement therapy, stress ulcer prophylaxis, and implementing a sepsis resuscitation bundle.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise stimulates the production of endorphins in the brain which elevate mood and reduce stress levels.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
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Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
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Information and Communication Technology in EducationMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 2)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐈𝐂𝐓 𝐢𝐧 𝐞𝐝𝐮𝐜𝐚𝐭𝐢𝐨𝐧:
Students will be able to explain the role and impact of Information and Communication Technology (ICT) in education. They will understand how ICT tools, such as computers, the internet, and educational software, enhance learning and teaching processes. By exploring various ICT applications, students will recognize how these technologies facilitate access to information, improve communication, support collaboration, and enable personalized learning experiences.
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐫𝐞𝐥𝐢𝐚𝐛𝐥𝐞 𝐬𝐨𝐮𝐫𝐜𝐞𝐬 𝐨𝐧 𝐭𝐡𝐞 𝐢𝐧𝐭𝐞𝐫𝐧𝐞𝐭:
-Students will be able to discuss what constitutes reliable sources on the internet. They will learn to identify key characteristics of trustworthy information, such as credibility, accuracy, and authority. By examining different types of online sources, students will develop skills to evaluate the reliability of websites and content, ensuring they can distinguish between reputable information and misinformation.
1. Surviving Sepsis Campaign Guidelines for
Management of Severe Sepsis and Septic Shock
This is a summary of the Surviving Sepsis Campaign In patients requiring vasopressors, place an arterial Prone ARDS patients requiring potentially injurious levels
Guidelines for Management of Severe Sepsis and Septic catheter as soon as practical. of FiO2 or plateau pressure. Only prone patients not at
Shock condensed from Dellinger RP, Carlet JM, Masur H, high risk from positional changes.
et al: Surviving Sepsis Campaign guidelines for management Consider vasopressin in patients with refractory shock
of severe sepsis and septic shock. Crit Care Med 2004; despite adequate fluid resuscitation and high-dose con- To prevent ventilator-associated pneumonia maintain
32:858-871. This version does not contain the rationale ventional vasopressors. Vasopressin is not recommended mechanically ventilated patients in a semirecumbent
or appendices contained in the primary publication. as a replacement for norepinephrine or dopamine as a position (head of bed raised 45 degrees), unless con-
Please refer to the guidelines for additional information first-line agent. Administer vasopressin at infusion rates traindicated.
at www.survivingsepsis.org. of 0.01–0.04 units/minute in adults.
Use a weaning protocol and have mechanically ventilated
∆ Indicates one of the goals chosen for implementation in Inotropic Therapy patients undergo a spontaneous breathing trial (SBT), at
the Institute of Healthcare Improvement's change pack- Consider dobutamine in patients with low cardiac output least daily, to evaluate for ventilation discontinuation.
age, i.e. part of the “sepsis bundle.” despite fluid resuscitation. Continue to titrate vasopressor
to mean arterial pressure of 65 mm Hg or greater. SBT options include a low level of pressure support with
continuous positive airway pressure 5 cm H2O or a
Initial Resuscitation Do not increase cardiac index to achieve an arbitrarily T-piece. Prior to SBT, patients should: 1) be arousable;
∆ Begin resuscitation immediately in patients with predefined elevated level of oxygen delivery. 2) be hemodynamically stable without vasopressors;
hypotension or elevated serum lactate. Resuscitation 3) have no new potentially serious conditions; 4) have low
goals: Steroids ventilatory and end-expiratory pressure requirement; and
• Central venous pressure: 8–12 mm Hg ∆ Treat patients who still require vasopressors despite fluid 5) require FiO2 levels that can be safely delivered with a
• Mean arterial pressure ≥65 mm Hg replacement with hydrocortisone 200–300 mg/day, for face mask or nasal cannula.
• Urine output ≥0.5 mL.kg -1.hr -1 7 days in three or four divided doses or by continuous
• Central venous or mixed venous oxygen infusion. Consider extubation if SBT is successful.
saturation ≥70%
Optional: Sedation, Analgesia, and Neuromuscular
∆ If central venous oxygen saturation or mixed venous • Perform 250-microgram adrenocorticotropic Blockade in Sepsis
oxygen saturation of 70% is not achieved with a central hormone (ACTH) stimulation test and discontinue Use sedation protocols for critically ill mechanically
venous pressure of 8–12 mm Hg, then transfuse packed steroids in patients who are responders (increase ventilated patients. Measure the sedation goal with a
red blood cells to achieve a hematocrit of ≥30% and/or in cortisol of > 9 µg/dL). standardized subjective sedation scale.
administer a dobutamine infusion of up to a maximum of
20 µg.kg-1.min-1. • Decrease steroid dose if septic shock resolves. Target sedation to predetermined endpoints (sedation
score). Use either intermittent bolus sedation or continu-
Diagnosis • Taper corticosteroid dose at end of therapy. ous infusion sedation with daily interruption/lightening
Before starting antibiotics obtain two or more blood to produce awakening. Retitrate if necessary.
cultures. At least one blood draw should be percutaneous • Add fludrocortisone (50µg orally once a day)
and one should be through each vascular assist device to this regimen. Avoid neuromuscular blockers (NMBs), if at all possible.
that has been in place longer than 48 hours. Obtain If NMBs must be utilized for longer than the first 2 to 3
cultures from other sites as indicated – cerebrospinal fluid, Do not use corticosteroids >300 mg/day of hydrocorti- hours of mechanical ventilation, use either intermittent
respiratory secretions, urine, wounds, and other body fluids. sone to treat septic shock. bolus as required or continuous infusion with monitoring
of depth of block with train of four monitoring.
Antibiotic Therapy Do not use corticosteroids to treat sepsis in the absence
∆ Begin intravenous antibiotics within first hour of recog- of shock unless the patient’s endocrine or corticosteroid Glucose Control
nition of severe sepsis. history warrants. ∆ Maintain blood glucose <150 mg/dL (8.3mmol/L)
following initial stabilization. Use continuous insulin
Administer one or more drugs that are active against likely Recombinant Human Activated and glucose infusion. Monitor blood glucose every 30 – 60
bacterial or fungal pathogens. Consider microorganism Protein C (rhAPC) minutes until stabilized, then monitor every 4 hours.
susceptibility patterns in the community and hospital. ∆ rhAPC is recommended in patients at high risk of death
(APACHE II(≥25, sepsis-induced multiple organ failure, Include a nutritional protocol for glycemic control.
Reassess antimicrobial regimen 48–72 hours after septic shock, or sepsis-induced acute respiratory distress
starting treatment with the objective of using a narrow syndrome) and with no absolute contraindication related Renal Replacement
spectrum antibiotic. to bleeding risk or relative contraindication that outweighs Intermittent hemodialysis and continuous veno venous
the potential benefit of rhAPC. hemofiltration (CVVH) are considered equivalent.
Consider combination therapy for neutropenic patients CVVH offers easier management in hemodynamically
and those with Pseudomonas infections. Blood Product Administration unstable patients.
Following resolution of tissue hypoperfusion, and in the
Stop antimicrobial therapy immediately if the condition absence of significant coronary artery disease or acute Bicarbonate Therapy
is determined to be a noninfectious cause. hemorrhage, transfuse red blood cells when hemoglobin Do not use bicarbonate therapy for the purpose of
decreases to <7.0 g/dL (<70 g/L) to target a hemoglobin improving hemodynamics or reducing vasopressor
Source Control of 7.0 – 9.0 g/dL. requirements when treating hypoperfusion induced lactic
∆ Evaluate patient for a focus of infection amenable to acidemia with pH ≥7.15.
source control measures including abscess drainage or Do not use erythropoietin to treat sepsis-related anemia.
tissue debridement. Erythropoietin may be used for other accepted reasons. Deep Vein Thrombosis (DVT) Prophylaxis
Use either low-dose unfractionated heparin or low-mole-
Choose the source control measure that will cause the Do not use fresh frozen plasma to correct laboratory cular weight heparin. Use a mechanical prophylactic
least physiologic upset and still accomplish the clinical clotting abnormalities unless there is bleeding or planned device, such as compression stockings or an intermittent
goal. invasive procedures. compression device, when heparin is contraindicated.
Use a combination of pharmacologic and mechanical
Institute source control measures as soon as an infection Do not use antithrombin therapy. therapy for patients who are at very high risk for DVT.
focus in need of source countrol has been identified.
Administer platelets when counts are <5000/mm3 (5 X Stress Ulcer Prophylaxis
Remove intravascular access devices that are a potential 109/L) regardless of bleeding. Transfuse platelets when Provide stress ulcer prophylaxis. The preferred agents
infection source promptly after establishing other vascu- counts are 5000 to 30,000/mm3 (5–30 X 109/L) and there are H2 receptor inhibitors.
lar access. is significant bleeding risk. Higher platelet counts
(≥50,000/mm3 [50 X 109/L]) are required for surgery or Consideration for Limitation of Support
Fluid Therapy invasive procedures. Discuss advance care planning with patients and
(see initial resuscitation timing recommendations) families. Describe likely outcomes and set realistic
Mechanical Ventilation of Sepsis-Induced expectations.
Use crystalloids or colloids. Acute Lung Injury (ALI)/ARDS
∆ Avoid high tidal volumes coupled with high plateau
∆ Give fluid challenge to patients with suspected inade- pressures. Reduce tidal volumes over 1–2 hours to a low Sponsoring Organizations: American Association of Critical-Care
quate tissue perfusion at a rate of 500 –1000 mL of tidal volume (6 ml per kilogram of lean body weight) as Nurses; American College of Chest Physicians; American
crystalloids or 300–500 mL of colloids over 30 minutes a goal in conjunction with the goal of maintaining College of Emergency Physicians; American Thoracic Society;
and repeat if blood pressure and urine output do not end-inspiratory plateau pressures <30 cm H2O. Australian and New Zealand Intensive Care Society; European
increase and there is no evidence of intravascular volume Society of Clinical Microbiology and Infectious Diseases;
overload. If necessary, minimize plateau pressures and tidal volumes European Society of Intensive Care Medicine; European
by allowing PaCO2 to increase above normal. Respiratory Society; Infectious Disease Society of America;
Vasopressors International Sepsis Forum; Society of Critical Care Medicine;
Start vasopressor therapy when fluid challenge fails to Set a minimum amount of positive end-expiratory pressure Surgical Infection Society.
restore adequate blood pressure and organ perfusion, or (PEEP) to prevent lung collapse at end expiration.
transiently until fluid resuscitation restores adequate Set PEEP based on severity of oxygenation deficit and
perfusion. guided by the FiO2 required to maintain adequate oxy-
genation (ARDSnet guidelines) or titrate PEEP accord-
Either norepinephrine or dopamine administered through ing to bedside measurements of thoracopulmonary com-
a central catheter is the initial vasopressor of choice. pliance.
This wall chart distributed by the Society of Critical Care Medicine
Do not use low-dose dopamine for renal protection.
Revised June 2004