Sandbox sepsis rsg: Difference between revisions

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'''TO BE COMPLETED WITHIN 3 HOURS:'''
'''TO BE COMPLETED WITHIN 3 HOURS:'''
* Measure lactate level
* Measure lactate level
* Obtain blood cultures prior to administration of antibiotics
* Administer 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L
* Administer 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L
 
* Administer empiric antibiotics [[Sepsis resident survival guide#Empiric Antibiotic Therapy|(details)]]
* Obtain blood cultures prior to administration of antibiotics
* Administer broad spectrum antibiotics
'''TO BE COMPLETED WITHIN 6 HOURS:'''
'''TO BE COMPLETED WITHIN 6 HOURS:'''
* Administer vasopressors for persistent hypotension to maintain MAP ≥65 mm Hg
* Administer vasopressors for persistent hypotension to maintain MAP ≥65 mm Hg
* For septic shock or initial lactate ≥4 mmol/L (36 mg/dL):
* For septic shock or initial lactate ≥4 mmol/L (36 mg/dL):
: - Measure CVP (target ≥8 mm Hg)
:— Measure CVP (target ≥8 mm Hg)
: - Measure ScvO2 (target ≥70%)
:— Measure ScvO2 (target ≥70%)
* Remeasure lactate if initial lactate was elevated
* Remeasure lactate if initial lactate was elevated
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Identify the source of infection: inspect lungs, abdomen, urine, wounds, and catheters.

Revision as of 20:31, 5 March 2015

FIRE: Focused Initial Rapid Evaluation

Focused Initial Rapid Evaluation (FIRE) should be undertaken to identify patients requiring urgent intervention.

Abbreviations: CBC, complete blood count; CI, cardiac index; CK-MB, creatine kinase MB isoform; CVP, central venous pressure; DC, differential count; ICU, intensive care unit; INR, international normalized ratio; LFT, liver function test; MAP, mean arterial pressure; PCWP, pulmonary capillary wedge pressure; PT, prothrombin time; PTT, partial prothrombin time; SaO2, arterial oxygen saturation; SBP, systolic blood pressure; ScvO2, central venous oxygen saturation; SvO2, mixed venous oxygen saturation; SMA-7, sequential multiple analysis-7.









 
 
 
 
 
 
 
Suspected sepsis
  • Fever (>38.3°C)
  • Hypothermia (core temperature <36°C)
  • Heart rate >90/min–1 or more than two SD above the normal value for age
  • Tachypnea
  • Altered mental status
  • Significant edema or positive fluid balance (>20 mL/kg over 24 hr)
  • Hypotension (SBP <90 mm Hg, MAP <70 mm Hg, or an SBP decrease >40 mm Hg)
  • Hypoxemia (Pao2/Fio2 <300)
  • Acute oliguria (urine output <0.5 mL/kg/hr for at least 2 hrs despite adequate fluid resuscitation)
  • Ileus (absent bowel sounds)
  • Decreased capillary refill or mottling
  • Hyperglycemia (plasma glucose >140mg/dL or 7.7 mmol/L) in the absence of diabetes
  • Leukocytosis (WBC count >12,000 μL–1)
  • Leukopenia (WBC count <4000 μL–1)
  • Bandemia >10% immature forms
  • C-reactive protein more than two SD above the normal value
  • Procalcitonin greater than two SD above the normal value
  • Creatinine increase >0.5mg/dL or 44.2 μmol/L
  • Coagulation abnormalities (INR >1.5 or aPTT >60 s)
  • Thrombocytopenia (platelet count <100,000 μL–1)
  • Hyperbilirubinemia (plasma total bilirubin >4mg/dL or 70 μmol/L)
  • Hyperlactatemia (>1 mmol/L)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Surviving Sepsis Campaign Care Bundles

TO BE COMPLETED WITHIN 3 HOURS:

  • Measure lactate level
  • Obtain blood cultures prior to administration of antibiotics
  • Administer 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L
  • Administer empiric antibiotics (details)

TO BE COMPLETED WITHIN 6 HOURS:

  • Administer vasopressors for persistent hypotension to maintain MAP ≥65 mm Hg
  • For septic shock or initial lactate ≥4 mmol/L (36 mg/dL):
— Measure CVP (target ≥8 mm Hg)
— Measure ScvO2 (target ≥70%)
  • Remeasure lactate if initial lactate was elevated
 
 
 

Identify the source of infection: inspect lungs, abdomen, urine, wounds, and catheters.

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