2. All Sepsis categories hold Tachycardia (HR > 90)
the same general clinical Warm skin, possibly
manifestations rash
Hyperthermia (>38 Generalized Weakness
degrees Celsius) High WBC count
Hypothermia (<36 (>12,000 µL-1)
degrees Celsius) Low WBC count
Difficulty Breathing (<4,0000 µL-1)
(Tachypnea, >20 BPM) Coagulation Imbalance
3. Severe Sepsis – in addition to general clinical
manifestations
Is categorized by having one or more vital organs affected
◦ Lungs
◦ Heart
◦ Kidney
◦ Liver
◦ Central Nervous System
9. Process of PES
P = Problem statement/diagnostic label/definition
E = Etiology/related factors/causes
S = Defining characteristics/signs and symptoms
10. Etiology/Related
Factors/Causes
Sepsis can be caused
from many different
infections in different
areas of the body. With
each body
system, bacteria has a
place to grow if given
the chance.
11. The lungs are the
major source of
infection in severe
sepsis (especially
with hospital-
acquired
infections), with
sepsis usually
associated with
pneumonia.
12. Infection in the
abdomen, eg, appendicitis,
bowel
problems, gallbladder
infections. When the outer
surface of the abdominal
organs (called the
peritoneum) is involved in
the infection, it is called
"peritonitis.“
Diabetic patients are also
at increased risk of urinary
infections leading to
sepsis. Sometimes this is
referred to as "urosepsis"
which just refers to sepsis
related to a urinary tract
infection.
(Surviving Sepsis
Campaign)
13. Bacteria enter the skin
through wounds and skin
inflammations; they also
enter the skin and blood
through an opening
provided by intravenous
("IV") catheters (small
tubes for dripping fluids),
which are required for the
administration of fluids
and/or medicines.
16. The goal is to perform all indicated tasks 100%of the
time within the first 6 hours of identification of severe
sepsis.
The tasks are:
1. Measure serum lactate
2. Obtain blood cultures prior to antibiotic
administration
3. Administer broad-spectrum antibiotic, within 3 hrs.
of ED admission and within 1 hour of non-ED
admission
17. 4. In the event of hypotension and/or a serum lactate > 4
mmol/L
◦ a. Deliver an initial minimum of 20 ml/kg of crystalloid or an
equivalent
◦ b. Apply vasopressors for hypotension not responding to initial fluid
resuscitation to maintain mean arterial pressure (MAP) > 65 mm Hg
5. In the event of persistent hypotension despite fluid
resuscitation (septic shock) and/or lactate > 4mmol/L
◦ a. Achieve a central venous pressure (CVP) of > 8 mm Hg
◦ b. Achieve a central venous oxygen saturation (ScvO2) > 70 % or
mixed venous oxygen saturation (SvO2) > 65 %
(Surviving Sepsis Campaign)
18. Efforts to accomplish these goals should begin
immediately, but these items may be completed within 24
hours of presentation for patients with severe sepsis or septic
shock.
1. Administer low-dose steroids for septic shock in accordance
with a standardized ICU policy. If not administered, document
why the patient did not qualify for low-dose steroids based
upon the standardized protocol.
19. 2. Administer drotrecogin alfa (activated) in accordance
with a standardized ICU policy. If not
administered, document why the patient did not qualify
for drotrecogin alfa (activated).
3. Maintain glucose control > 70, but < 150 mg/dl
4. Maintain a median inspiratory plateau pressure (IPP)* <
30 cm H2O for mechanically ventilated patients
20. Apache II Score
Measure Serum Lactate Levels
Blood cultures
Initiate IV Antibiotic Therapy
Treatment of Hypotension
Keep oxygen saturation stable/Ventilator
21. Broad Spectrum Antibiotics should
be administered within 3 hours of
suspected Severe Sepsis or Septic
Shock
Blood cultures need to be drawn
before antibiotics are started
22. Treat Hypotension
If presenting with hypotension and/or lactate level of
>4 mmol/L give 20mL/kg of crystalloid solution
◦ Lactated Ringer’s
◦ Normal saline
Fluid administration to reach a CVP of >8mm Hg
23. When patients do not respond to initial fluid
resuscitation, use vasopressor therapy to maintain a
MAP > 65mm Hg
◦ Dopamine
◦ Norepinephrine
◦ Titrate according to protocol
24. Blood cultures should be re-evaluated in 48
hours to determine specific antibiotic therapy
Continue monitoring patient’s vital signs till
hemodynamically stable
Follow protocols for PICC dressing, hand
washing, dressing changes, and peri care
26. http://www.survivingsepsis.org/SiteCollectionDocumen
ts/Pathophysiology%20of%20Sepsis%20Phil(2).pdf
Surviving Sepsis Campaign, 2010
Dellinger, P., Levy, M., Carlet, J., Bion, J., Parker, M.,
Jaeschke, R.,et al (2008). Surviving Sepsis Campaign:
International guidelines for management of severe
sepsis and septic shock. Critical Care Medicine, 1-33,
DOI: 10.1097/01.CCM.0000298158.12101.41.
27. Wesley, E., Kleinpell, R., Goyette, R., (2003).
Advances in the understanding of clinical
manifestations and therapy of severe sepsis: An update
for critical care nurses. American Journal of Critical
Care, 12(2),120-133. Retrieved from
http://ajcc.aacnjournals.org/content/12/2/1
20.full