Sepsis id what?
A syndrome
- a group of body dysfunctions found together
- dysfunctions progress together in a predictable delay
- high mortality rate, variable clinical presentations
Sepsis Compared to Anaphylaxis
- both have initial injury
- both result in organ dysfunction/cardio collapse
- anaphylaxis is quick and obvious/sepsis is slow and subtle
SIRS Criteria
- temp <36 C or >38 C
- HR > 90
- RR > 20
- WBC < 4000 or > 12000
Normal Response to Infection
- vasodilation
- vessel permeability
- once infection is controlled tissue repairs itself
Risk Factors for Sepsis
- extremes of age
- developmental delay
- neuro disorder (Cerebal Palsy)
- recent surgery
- pregancy/miscarriage
- reduced immunity
S/S of Sepsis
- FEVER
- chills/shaking
- myalgias/arthralgias
- n/v
- flu like symptoms
- mental status changes
- increased fatigue/lethargy
Fever may be the most seen symptom but who does not often appear w/ a fever?
Elderly
Causes of Sepsis
- pneumonia
- UTI
- infection after abdominal surgery
- skin infections
- C Diff
- bacteremia from IV
What to look for to identify sepsis?
- SIRS criteria in vitals
- shock/dehydration
- check end-tidal CO2
How to Treat Sepsis
- SpO2 > 92%
- NRB/CPAP/invasice airway
- 2 large bore IV
- 30 ml/kg NS bolus
- may repeat if lungs remain clear
What medication has been seen to worsen the survival rate from Sepsis?
Dopamine
What medication is best for Sepsis?
- IV fluid resuscitation
- norepinephrine (Levophed)
- vasopressin
Respiratory Component of Sepsis
- mismatch of oxygen availability to changing needs of organs
- respiratory failure happens quickly
- ARDS
Severe Sepsis is the most common cause of what?
ARDS
S/S of ARDS
- diffuse rales
- rhonchi
- respiratory failure
What is a key development preceding multi-organ failure and death?
Global tissue hypoxia
Pitfalls of Sepsis
- betablockers block tachycardia
- altered mentation not recognized as organ failure
- temps not checked or documented correctly
- alert fatigue
You can not diagnose a patient w/ sepsis until what happens?
You diagnose a source
NEED DIAGNOSIS
You CAN diagnose SIRS w/o a what?
cause
To go from severe sepsis to septic shock you have to have had what?
Your diagnosed w/ hypotension and you’ve given 30 ml bolus and you are still hypotensive
