MICU Intern's survival guide sepsis

Jump to navigation Jump to search

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Sepsis Microchapters

Home

Patient Information (Adult)

Patient Information (Neonatal)

Overview

Pathophysiology

Causes

Differentiating Sepsis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

MICU Intern's survival guide sepsis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of MICU Intern's survival guide sepsis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on MICU Intern's survival guide sepsis

CDC on MICU Intern's survival guide sepsis

MICU Intern's survival guide sepsis in the news

Blogs on MICU Intern's survival guide sepsis

Directions to Hospitals Treating Sepsis

Risk calculators and risk factors for MICU Intern's survival guide sepsis

Overview

Systemic Inflammatory Response Syndrome [1] [2]

  • SIRS can be diagnosed when two or more of the following are present:[3]
    • Heart rate > 90 beats per minute
    • Temperature < 36 (96.8 °F) or > 38 °C (100.4 °F)
    • Tachypnea > 20 breaths per minute or, on blood gas, a PaCO2 < 32 mm Hg
    • White blood cell count < 4000 cells/mm³ or > 12000 cells/mm³ (< 4 x 109 or > 12 x 109 cells/L), or > 10% band forms (immature white blood cells / bandemia).
  • SIRS can be seen in non infectious conditions like pancreatitis and myocardial infarction.

Sepsis

  • SIRS + Source of infection

Severe sepsis

  • Sepsis + organ dysfunction
  • Organ damage can present as decreased urine output, acute kidney injury, and elevated liver function tests.

Septic shock

  • Severe sepsis + persistent hypotension after adequate fluid challenge.

Multiple organ dysfunctions (MODS)

  • Progressive multiple organ failure secondary to severe sepsis.

Sepsis management

Source control

Source identification

  • Depending on the patient's history sputum, blood, urine or other sources can be cultured. In case of unclear source, pan-culture should be done.
  • Based on the patient's history proper imaging should be initiated.

Source management

  • Initiation of proper antibiotic within an hour of diagnosis.
  • Drainage in cases of an abscess should be done.

Resuscitation

Hypotension

  • Fluids are the first line management
    • Crystalloids like normal saline, ringer lactate are the first to be used.
    • Normal rate of infusion is 40-60ml/kg.
  • If patient still hypotensive after fluid challenge plan to insert a central venous line to guide additional fluid therapy. An internal jugular and subclavian lines are preferred.
  • CVP should be checked in Q30 minutes for adequate fluid management.
  • Target CVP are:
    • 10-12 in non-intubated patients.
    • 12-15 in intubated patients.
  • If patient still hypotensive start vasopressors.
    • Nor-epinephrine is the first line vasopressor agent.
    • Dopamine and vasopressin are second line agents
    • Goal mean arterial pressure should be 65.
    • Continue to bolus for CVP.
  • If patient still hypotensive check ScvO2

Resuscitation

References

  1. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL (2008). "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008". Critical Care Medicine. 36 (1): 296–327. doi:10.1097/01.CCM.0000298158.12101.41. PMID 18158437. Retrieved 2012-09-16. Unknown parameter |month= ignored (help)
  2. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992 Jun;101(6):1644-55. PMID 1303622.
  3. Tslotou AG, Sakorafas GH, Anagnostopoulos G, Bramis J. Septic shock; current pathogenetic concepts from a clinical perspective. Med Sci Monit. 2005 Mar;11(3):RA76-85. PMID 15735579. Full Text.

Template:WH Template:WS