Transcript Sepsis Project Presentation 3744KB Jan 14 2015 08:21:43 AM

George Adolf
Myths
 The elderly, for the most part are the
only people who contract sepsis.
 Sepsis only affects people with preexisting conditions.
 Sepsis is the same thing as blood
poisoning (septicemia).
 Sepsis and septic shock are always
fatal.
Incidence
 Over 750,000 patients are
diagnosed with sepsis annually, with
an increase of 90% in the number of
diagnoses over the last 10 years.
 The cause for this is believed to be
the rise of drug-resistant bacteria
Mortality
 In otherwise healthy individuals, the
mortality rate for sepsis is 5%
 If severe sepsis develops, mortality
rises sharply
 If hypotension (the hallmark of
septic shock) is present, mortality
rises to 50%
At-Risk Populations
 Elderly, infants, surgical patients,
chronically ill and immunosupressed patients are all at
increased risk of contracting sepsis
because of compromised or
diminished immune function.
 The mortality rates for these
catagories are also raised.
Definitions
 a.
Sepsis – a SIRS response triggered by
infection
 b.
Septicemia – sepsis originating from an
infection in the bloodstream
 c.
Systemic Inflammatory Response
Syndrome – systemic (bodywide) immune
response meeting two or more of the following
criteria




i. Temperature above 100.4 ˚F , below 96.8 ˚F
ii. HR > 90 bpm
iii.
RR > 20 or PaCO2 < 32 mmHg
iv.Extreme high/low WBC count
S/S of Sepsis
 a.
Chills, low grade fever, shaking,
body aches, N&V, vertigo, other flu-like
symptoms
 b.
Occasional AMS including
confusion, lethargy and increased fatigue
Purpura/rash in
children with sepsis
caused by
meningococcal
infection
Influenza vs. Sepsis
Sepsis can be misdiagnosed as the
flu because symptoms are nearly
identical often. Try to rule out
sepsis when considering a diagnosis
of influenza.
Sources of Infection
 Dirty wounds (debris)
 Complex wounds (open fractures)
 Burns
 Puncture wounds
 Impaled Objects
 Crush Injuries
Infected Wounds
Progression of Sepsis
 a. Local infection occurs triggering non-specific
inflammatory cell response
 i.
Vasodilation occurs allowing more
blood to reach infected area enhancing
immune response by allowing increased
movement of antibodies and immune cells
(Phagocytes) into affected area in order to
combat infection
 ii.
Increased Local Vessel Permeability
Increases, permits antibodies & phagocytes to
move out of bloodstream into surrounding
infected cells
Sepsis Chain
Image: various causes & signs of infection/sepsis
Progression of Sepsis cont.
 b.
Local Inflammatory Response
Ineffective > infection spreads beyond
original location
 c.
Body initiates systemic
inflammatory response to infection >
infection becomes sepsis at this point
Progression of Sepsis cont.
 d.
Severe sepsis
 i. Organ dysfuntion, poor perfusion or
hypotension
 ii. Characterized by: hypotension (<90 mmHg
systolic), altered mental state, hyperglycemia w/o
Hx of diabetes, hypoxemia, & decreased urine
output
 iii. Body’s response to severe sepsis > release of
histamines, prostaglandins, cytokines causing
systemic vasodilation and increased capillary
permeability> fluid shift from intravascular space
to the extravascular space > increased systemic
inflammation & relative hypovolemia causing
hypotension
Progression of Sepsis cont.
 e.
Septic Shock
 i. When aggressive fluid replacement and
vasopressors fail to maintain a SBP of at least
90 w/ continued signs of severe sepsis > pt
now in septic shock (tx increasingly difficult,
mortality now over 50%)
Progression of Sepsis cont.
 f.
Multiple organ dysfunction
Syndrome
 i. Two or more organs fail to function
properly, homeostasis not maintained without
aggressive interventions
 ii.MODS will develop within 3-5 days of
uncorrected septic shock
 iii.
Final stage of an infection that has
overtaken the body > death shortly
Assessment
 a. ABCs, manage critical problems
 b. Complete SAMPLE hx
 i.
How long has pt been ill?
 ii.
Is there any hx of infections?
 iii.
Prior medical
complications/conditions?
 iv.
Any surgeries?
 v.
Pain or fever?
 c. Complete physical exam
 i.
Sick/Not Sick
 ii.
Signs of infection?
A sign of infection
A bad IV site
Management of Sepsis
 a.
Oxygen – patients with sepsis have an
increased oxygen demand, oxygen supply to tissue
is often inadequate even with supplemental O2 in
patients with severe sepsis
 b.
Ventilatory Support – patients with severe
sepsis often require mechanical ventilatory
support, consider intubation and the use of a
respirator if available
 c.
Capnography and Pulse Oximetry to
maintain SpO2 above 90, and monitor PaCO2 –
respiratory alkalosis (PaCO2 < 32 mmHg) is
common
Management of Sepsis
cont.
 d.
Monitor hypotension and use fluid
replacement, Trendelenburg position to maintain
adequate BP
 e.
Initiate IV access – consider large bore IVs
for aggressive Tx with crystalloid solutions, bolus
in 500 mL increments to maintain SBP of at least
90 mmHg
 f.
Consider vasopressors (dopamine) for pts
not responsive to fluid boluses
 g.
Once infection successfully located or
suspected consider IV antibiotics if available –
some EMS agencies are beginning to carry drugs
such as Rocephin
Keep in mind:
Septic patients are prone to rapid
deterioration, ALS providers should be
utilized if available
 rapid transport if airway compromise or
inadequate respiration; registers V,P, or U on
AVPU scale; unstable vitals or oral
temperature > 100˚F