SIRS S EPSIS S EVERE S EPSIS S EPTIC S HOCK D EATH Early recognition Early antibiotics Source control.

Slides:

Advertisements

Similar presentations

Pediatric Septic Shock

Advertisements

The golden hour(s) for severe sepsis and septic shock treatment

SEPSIS KILLS program Paediatric Inpatients

The Duration of Hypotension Prior to Initiation of Effective Antimicrobial Therapy is the Critical Determinant of Survival in Human Septic Shock Anand.

The New Surviving Sepsis Bundles: From Time Zero to Tomorrow

Survival benefits and policy conflicts in Sepsis

A Randomized Trial of Protocol-Based Care for Early Septic Shock Andrea Caballero, MD January 15, 2015 LSU Journal Club The ProCESS Investigators. N Engl.

Copyright Wigfull 2013 The Sepsis Timebomb James Wigfull Critical Care and Anaesthesia Sheffield Teaching Hospitals.

SEPSIS KILLS program Adult Inpatients

Serum Lactate Post-Antibiotic antibiotic † † ＊＊ Kumar et al. J Infect Dis 2006; 193:

Compliance with Severe Sepsis Protocol: Impact on Patient Outcomes Lisa Hurst RN BSN CCRN and Kim Raines RN CCRN References The purpose of this study is.

Shock and Sepsis 2 of 2 William Whitehead, M.D., Ph.D. Department of Anesthesiology.

Severe Sepsis Initial recognition and resuscitation

FROM CEM SEPSIS TOOLKIT PAPERS TO COVER NGUYEN EARLY LACTATE CLEARANCE IS ASSOCIATED WITH IMPROVED OUTCOME IN SEVERE SEPSIS AND SEPTIC SHOCK P Single.

Septic Shock Daniel Henning, MD, MPH Acting Instructor Harborview Medical Center Division of Emergency Medicine.

Early Goal Therapy in Severe Sepsis & Septic Shock

1 Kumar et al. CCM. 2006:34: Cumulative Initiation of Effective Antimicrobial Therapy and Survival in Septic Shock time from hypotension onset.

Surviving Sepsis Michael Stewart CT2 EM

SEPSIS Early recognition and management. Aims of the talk Understand the definition of sepsis and severe sepsis Understand the clinical significance of.

Pneumonia and Sepsis By Oliver Putt and Priyanca Patel For WMS Peer Support – 11 th November 2014.

Applying the Surviving Sepsis Campaign Guidelines to Clinical Practice

Early Goal-Directed Therapy in Pediatric Sepsis Derek S. Wheeler, MD, FAAP, FCCP, FCCM Associate Professor of Clinical Pediatrics University of Cincinnati.

SEPSIS Where are the goal posts now?. What is the new evidence? RCTs: Trilogy of EGDT trials ( ) RCT: SEPSIS-PAM (2014) RCT: ALBIOS (2014) Observational.

SEPSIS & SEPTIC SHOCK Jaime Palomino, MD Pulmonary & Critical Care Medicine Tulane University Health Sciences Center New Orleans, Louisiana.

SIRS Dr. Jonathan R. Goodall M62 Coloproctology Course 31 st March 2006.

Sepsis Douglas Stahura D.O. Grandview Hospital March 21, 2001.

National Sepsis Audit National Registrar Research Collaborative Audit Project 2013 Nationally led by SPARCS (Severn and Peninsula Audit and Research Collaborative.

The New Paradigm: Goal-Directed Therapy for Severe Sepsis and Septic Shock Jamie Cowan April 25, 2006 Emergency Medicine Clerkship.

Sepsis. 54 year old man with a past history of smoking and diabetes presents to the emergency department with a one week history of progressive unwellness.

The changing face of sepsis.

Virtual Journal Club ACMQ

LRTIs and Sepsis Poppy. Bronchitis/Pneumonia Bronchitis ▫Infection & inflammation of airways Pneumonia ▫Infection & inflammation of alveoli.

Sepsis Alert – Clinical Decision Support Maternal Newborn eHR

United States Statistics on Sepsis

2016 Sepsis Update: Pearls, Pitfalls, and Core Measure Quicksand

Dr Alex Hieatt, EM Consultant MEHT Dr Ron Daniels, Chair of the UK Sepsis Trust and Global Sepsis Alliance (Slides with permission.)

Dr Michelle Webb Renal Consultant, Associate Medical Director Patient Safety, East Kent Hospitals University NHS Foundation Trust and Co-lead for Sepsis.

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y j 내과 R2 이지영.

Introducing ‘Sepsis 6’ at RACH. Important definitions SIRS Sepsis Severe sepsis Septic shock.

Sepsis (adults) September 2015.

Update in Critical Care Medicine Ann Intern Med 2007;147:

Preventing Sepsis in Wales

Sepsis-3 new definitions of sepsis and septic shock

UNC Hospitals Sepsis Mortality Reduction Initiative General CMS Compliant Sepsis Training Updated Code Sepsis.

Sepsis Improvement Team

Code Sepsis: Current Evidence Based Guidelines and the CMS Sepsis Core Measure Adult Patients - Abbreviated Updated May 26, 2017.

Code Sepsis: Current Evidence Based Guidelines and the CMS Sepsis Core Measure Adult Patients Updated May 26, 2017.

Code Sepsis: Current Evidence Based Guidelines and the CMS Sepsis Core Measure Adult Patients - Abbreviated Updated August 30, 2017.

SEPSIS Recognition, Treatment and Referral

Sepsis Surgeon Champions Talking Points

Time is Life in Sepsis! Are scores and numbers all we worry about?

The Duration of Hypotension Prior to Initiation of Effective Antimicrobial Therapy is the Critical Determinant of Survival in Human Septic Shock Anand.

‘TAP THE TAZ’ Liz Casey A/Resuscitation & EWS Training Officer

Code Sepsis: Current Evidence Based Guidelines and the CMS Sepsis Core Measure Adult Patients - Abbreviated Updated August 30, 2017.

SEPSIS – What is Sepsis? <insert date>

Respiratory Therapists & Sepsis: How we can work together

Sepsis: How Laboratory Can Help Mackenzie Roesti, RN, MSN, CCRN

Biomarker-Driven Management of Sepsis and Antibiotics Evidence and Perspectives.

Time is Life in Sepsis! Are scores and numbers all we worry about?

Improving Outcomes for Severe Sepsis and Septic Shock: Tools for Early Identification of At-Risk Patients and Treatment Protocol Implementation Emanuel.

Sepsis Dr Helen Dillon June 2017.

Severe sepsis Is there an infection?

Recognising sepsis and taking action

Infections in Surgical Patients: Intensive Care Unit

Optimizing Outcomes in Sepsis Dr. Anand Kumar

Should I still screen for possible sepsis with SIRS criteria?

Time is Life in Sepsis! Are scores and numbers all we worry about?

Severe sepsis Is there an infection?

Sepsis George Bailey Emergency Department, St Mary’s Hospital.

Presentation transcript:

SIRS S EPSIS S EVERE S EPSIS S EPTIC S HOCK D EATH Early recognition Early antibiotics Source control

SIRS S EPSIS S EVERE S EPSIS S EPTIC S HOCK D EATH Temperature: >38.3 or < 36 o C Heart Rate: >90bpm Respiratory Rate: >20 WCC: >12 or <4

SIRS

newsing [new  sing] verb 1.a NEWS aggregate score of 5 or more (or red in one parameter), sufficient to prompt clinician referral she is newsing at 8

Kaukonen et al. NEJM ;372(17):

Patients With Severe Sepsis SIRS -ve SIRS +ve SIRS miss 1 in 8

T IME F OR C HANGE ?

Organ dysfunction should prompt consideration of infection

R ESPIRATORY : Pa02/FiO2 ratio N EUROLOGICAL : GCS C ARDIOVASCULAR : MAP or drugs C OAGULATION : Platelets L IVER : Bilirubin R ENAL : Creatinine and urine output SOFA Score February 2016 qSOFA

Krebs cycle Pyruvate Glucose Glycolysis Anaerobic Aerobic Lactate Anaerobic

Lactate Time Poor prognosis Better prognosis Resuscitation

Time is Cytokine 8% per hour Antibiotic delays increase mortality

Kumar et al. Crit Care Med (6):

Statistical significance only reached after 3 hours Ferrer R et al. Crit Care Med (8): Empiric Antibiotic Treatment in Severe Sepsis and Septic Shock Time to Antibiotic hr -1

A NTIBIOTIC S TEWARDSHIP D ELAYED T HERAPY

45% mortality 30% mortality Rivers et al. NEJM : Early Goal Directed Therapy

International Multicentre Prevalence Study on Sepsis (IMPRESS Study) 30% (14%) 26% 44% 26% 36% 35% Hospital mortality 20% v 31% if compliant with 3 hour sepsis bundle

S OURCE C ONTROL

F LUID Resuscitation

Meant is not said, said is not heard, heard is not understood, understood is not done. “ ”