Identifying and treating the stages of sepsis The Spectrum of Sepsis Identifying and treating the stages of sepsis

Objectives

Importance to CC nurses Sepsis is the leading cause of death in hospitalized patients Sepsis mortality rates are 23-43% in critical care units Costs over 400 billion dollars annually

Some definitions Bacteremia Systemic inflammatory response (SIRS) Bacterial infection in the bloodstream Systemic inflammatory response (SIRS) Organ inflammation in response to an insult Sepsis A systemic response to the bacterial infection SIRS + organism = sepsis Severe Sepsis Sepsis with organ hypoperfusion, hypotension and dysfunction Septic Shock Hypotension and hypoperfusion despite fluids Multiple organ dysfunction syndrome Progressive failure of 2 or more organ systems

Risk Factors

Screening for Sepsis

Assessing for SIRS Hyperthermia (>100.4 F) (>38.3 C) Hypothermia (<96 F) (<36 C) Leukocytosis (>12) Leukopenia (<4) Tachycardia (>90) Normal WBC with >10% bands Tachypnea (>20) AMS Hyperglycemia (>120 in NON DIABETIC patients)

Assessing for MODS SBP <90 or MAP <65 SBP decrease >40 (from patient baseline) SPO2 <90% on RA or increasing need for supplemental oxygen (keep increasing amount of oxygen needed) (NOT someone who is on constant 2L O2 with NO increasing need of more O2) Bilirubin >2, AST >90, ALT >90 Platelets <100 Coagulopathy (INR >1.5) NOT on Coumadin (b/c then we want it 1-2, 2-3) CR >2 / UOP < 0.5 mL/kg/hr (this is the minimum!) Lactate >4

Treatments