Sandbox sepsis rsg: Difference between revisions
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==FIRE: Focused Initial Rapid Evaluation== | ==FIRE: Focused Initial Rapid Evaluation== | ||
<span style="background: #FFF0F5; font-weight: bold; font-style: italic;">Focused Initial Rapid Evaluation (FIRE)</span> should be undertaken to identify patients requiring urgent intervention. | <span style="background: #FFF0F5; font-weight: bold; font-style: italic;">Focused Initial Rapid Evaluation (FIRE)</span> should be undertaken to identify patients requiring urgent intervention. | ||
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<div style="font-size: 90%;"> | <div style="font-size: 90%;"> | ||
{{Familytree/start}} | {{Familytree/start}} | ||
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px;| | | | | | | | A01 | | | |A01=<div style="padding: 15px;"><BIG> | {{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px;| | | | | | | | A01 | | | |A01=<div style="padding: 15px;"> | ||
<BIG><B>Suspected sepsis</B></BIG> | |||
---- | ---- | ||
<ul class="mw-collapsible | <ul class="mw-collapsible" data-expandtext="Signs and Symptoms" data-collapsetext="Signs and Symptoms"> | ||
<li> Fever (>38.3°C)</li> | <li> Fever (>38.3°C)</li> | ||
<li> Hypothermia (core temperature <36°C)</li> | <li> Hypothermia (core temperature <36°C)</li> | ||
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<li> Diminished capillary refill or mottling</li> | <li> Diminished capillary refill or mottling</li> | ||
</ul> | </ul> | ||
<ul class="mw-collapsible | <ul class="mw-collapsible" data-expandtext="Laboratory Findings" data-collapsetext="Laboratory Findings"> | ||
<li> Hyperglycemia (plasma glucose >140mg/dL or 7.7 mmol/L) in the absence of diabetes</li> | <li> Hyperglycemia (plasma glucose >140mg/dL or 7.7 mmol/L) in the absence of diabetes</li> | ||
<li> Leukocytosis (WBC count >12,000 μL–1)</li> | <li> Leukocytosis (WBC count >12,000 μL–1)</li> | ||
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</div>}} | </div>}} | ||
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px;| | | | | | | | |!| | | |}} | {{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px;| | | | | | | | |!| | | |}} | ||
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px;| | | | | | | | B01 | | | |B01=<div style="padding: 15px;"><BIG>''' | {{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px;| | | | | | | | B01 | | | |B01=<div style="padding: 15px;"> | ||
<BIG>'''Early Goal-Directed Therapy'''</BIG> | |||
---- | ---- | ||
'''TO BE COMPLETED WITHIN 3 HOURS:''' | * Supplemental oxygen ± intubation / ventilatory support ± sedation | ||
* Arterial and central venous line placement | |||
<BIG>'''Preload Optimization'''</BIG> (Goal: CVP 8–12 mm Hg or PCWP 15–18 mm Hg) | |||
---- | |||
* Fluid challenge protocol [[Sepsis resident survival guide#Fluid Challenge Protocol|(details)]] | |||
* ± Correct pulmonary congestion [[Sepsis resident survival guide#Pulmonary Congestion|(details)]] | |||
:* [[Furosemide]] | |||
::* Usual dose: 40 mg slow IV injection | |||
::* May titrate to 80 mg after 1 hour as needed | |||
:* [[Morphine]] | |||
::* Usual dose: 2–4 mg slow IV injection | |||
::* May repeat dose every 5–30 minutes as needed | |||
<BIG>'''Afterload Optimization'''</BIG> (Goal: MAP 65–90 mm Hg) | |||
---- | |||
</div>}} | |||
{{Familytree/end}} | |||
<!-- | |||
<ul class="mw-collapsible" data-expandtext="Show Surviving Sepsis Campaign Care Bundles" data-collapsetext="Surviving Sepsis Campaign Care Bundles"> | |||
<li>'''TO BE COMPLETED WITHIN 3 HOURS:''' | |||
* Measure lactate level | * Measure lactate level | ||
* Obtain blood cultures prior to administration of antibiotics | * Obtain ≥2 sets of 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)]] | * Administer empiric antibiotics [[Sepsis resident survival guide#Empiric Antibiotic Therapy|(details)]]</li> | ||
'''TO BE COMPLETED WITHIN 6 HOURS:''' | <li>'''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</li> | ||
</ | </ul> | ||
--> | |||
</div> | </div> | ||
Revision as of 19:40, 6 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
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Early Goal-Directed Therapy
Preload Optimization (Goal: CVP 8–12 mm Hg or PCWP 15–18 mm Hg)
Afterload Optimization (Goal: MAP 65–90 mm Hg) | |||||||||||||||||||||||||