Sepsis
Sponsored Links
This presentation is the property of its rightful owner.
1 / 31

Sepsis PowerPoint PPT Presentation


  • 57 Views
  • Uploaded on
  • Presentation posted in: General

Sepsis. Presentation to Clinical Officers at Lewanika Hospital in Mongu Western Zambia [via Skype] February 2014 Dr Glynn Jones on behalf of OKAZHI. Goals of this presentation.

Download Presentation

Sepsis

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Sepsis

Presentation to Clinical Officers at Lewanika Hospital in Mongu Western Zambia [via Skype] February 2014

Dr Glynn Jones on behalf of OKAZHI


Goals of this presentation

  • At the end of this presentation participants will have an understanding of the patho - physiology of sepsis, leading to early recognition and treatment

  • The importance of the first 2 hours will be emphasized


Definitions


Infection

  • Is the invasion of normally sterile tissue by organisms


Bacteremia

  • Is the presence of viable bacteria in the blood


Sepsis

  • Is defined as the presence [probable or documented] of infection together with systemic manifestations of infection


Diagnostic criteria for sepsis

  • Include infection [documented or suspected] and some of the following:

    • Temperature > 38.3 or < 36o Celsius

    • Heart rate > 90 beats/min or more than 2 standard deviations above normal value for age

    • Tachypnea, respiratory rate > 20 breaths/min

    • Altered mental status

    • Significant edema

    • Hyperglycemia


Inflammatory variables

  • Leukocytosis [WBC count > 12,000 ] or leukopenia [WBC count <4000]

  • Plasma C reactive protein, Procalcitonin


Hemodynamic variables

  • Arterial hypotension [systolic BP < 90 mmHg]


Organ dysfunction variables

  • Arterial hypoxemia

  • Acute oliguria [urine output <0.5 ml/kg/hr for at least 2 hours despite adequate fluid resuscitation]

  • Coagulation abnormalities

  • Thrombocytopenia

  • Hyperbilirubinemia


Tissue perfusion variables

  • Hyperlactatemia

  • Decreased capillary refill or mottling


Symptoms of Malaria


Meningitis


Management during the first 2 hours

  • Recognize – Clinical diagnosis of severe sepsis or septic shock

    • Suspected infection

    • Hypotension (systolic blood pressure<

    • 90mmHg] and one or more of the

    • following:

      pulse> 100bpm

      respiratory rate >24

      abnormal temperature [<36o or >38o C]


Fix the physiology

  • Oxygen:

    • titrate toSpO2 90

  • Fluids:

    • After initial bolus of 1000ml continue rapid fluids LR or NS at 20ml/kg/hr up to 60ml/kg within the first 2 hours.


Treat infection

  • Urgent empirical antimicrobials

  • Antibiotics

  • Antimalarials

  • Influenza – specific antiviral if suspect influenza


Identify source of infection

  • Use sign or symptoms to consider source

  • Malaria test

  • TB or AFB smear of sputum, if cough

  • CXR, Gram – stain sputum

  • Send blood for cultures


Monitor Record

  • Every 30 minutes until stable then every hour

  • SBP pulse

  • Respiratory rate

  • SpO2

  • Mental status

  • JVP, auscultate for crackles


Check results of emergency laboratory

  • If hemoglobin < 7 mg/dl [Hct <20]

    • consider transfusion

  • If glucose < 3 mmol/l

    • then give D50 [25 – 50 ml] iv


If respiratory function declining [increasing RR, falling SpO2]

  • Check oxygen supply

  • If JVP elevated and/or increasing crackles

    • consider fluid overload


Take Home Message

  • Sepsis is common

  • Be vigilant

  • Recognize and intervene early

  • Early intervention yields results and gives the best chance of avoiding progressing down the sepsis pathway ending in multi organ failure and death.


Thank you for your attention


  • Login