1. Summer Gupta, MSN, RN Sepsis Coordinator UCLA Health 09/13/2016
CSI Case Study – Severe Sepsis/
Septic Shock
Summer Gupta, MSN, RN
Sepsis Coordinator UCLA Health
09/13/2016

2. Objectives Identify TOP for Severe Sepsis/Septic Shock
Know how to activate the nurse driven protocol and notify provider
Activate the bundle in a timely manner and anticipate order for abx and IVF bolus

3. What you already know… Continuum Bundle Elements
Sepsis = 2 SIRS + Infection
Severe Sepsis = Sepsis + New or Acute Organ Dysfunction
Septic Shock = Severe Sepsis + Persistent Hypotention OR lactate ≥ 36
Bundle Elements
Blood Cultures x 2 sets
Lactate and Repeat Lactate
IV Broad Spectrum Abx
IVF Bolus
Vasopressors
Tissue Perfusion Assessment

4. Case Study 1
83-year-old female presents to ED 04/09 with c/o gradual onset of productive cough x 1 month.
History of asthma and psoriasis.
Associated symptoms included generalized weakness, decreased appetite, weight loss, SOB, dizziness, and jaundice.
Initial Vital Signs
T 36.6
BP 127/58
HR 90
RR 18

5. Case Study 1
Admit diagnosis by ED Provider – Acute renal failure, Acute jaundice
Pt transferred to floor
Blood cultures drawn while in ED = Negative
04/13, WBC noted to be but no other SIRS present
04/15, WBC noted to be 20.65, HR 104, RR 24
RN Screen answered YES to Infection 04/15
BP previously normal dropped to 70/36 04/15
Severe Sepsis documentation by MD on 04/16

6. Sepsis Audit Tool

7. Sepsis Audit Tool

8. Sepsis Audit Tool

9. What is the Time of Presentation (TOP)?
SIRS
HR 1317
RR 1317
Infection
RN 0845
Organ Dysfunction
BP 1317

10. What would you do next? Implement the Nursing Protocol Call physician
Draw blood cultures
Draw initial lactate
Anticipate repeat lactate
Call physician
Anticipate order for IV Broad Spectrum Abx
Anticipate order for IVF Bolus 30ml/kg

11. Case Study 2
59-year-old male who presented to ED 07/23 with c/o gradual onset AMS per caregiver.
History of metastatic breast cancer, obstructive jaundice, and ascites. Per EMS, pt was picked up for BP 60/30.
Initial BG was 24. Pt given D50 and BG improved to Pt remains unresponsive.
Initial vital signs
T unknown
HR 78
RR 16
BP 90/60

12. Sepsis Audit Tool

13. Sepsis Audit Tool

14. What is the TOP? SIRS Infection Organ Dysfunction RR 24 @ 1045
Septic Shock documentation by ED 1015
Organ Dysfunction
BP 1045

15. What would you do next? Implement the Nursing Protocol Call physician
Draw blood cultures
Draw initial lactate
Anticipate repeat lactate
Call physician
Anticipate order for IV Broad Spectrum Abx
Anticipate order for IVF Bolus 30ml/kg

16. Case Study 3
53-year-old female presents to ED 08/06 with c/o sudden onset fever.
History of HTN, hyperlipidemia, and large B cell lymphoma. Last chemo 07/27.
Pt was at clinic in the am for lab draw and was informed to come to ED for hemoglobin of 6. At this time, the fever was identified.
Initial vital signs
T 38.9
HR 118
RR 16
BP 104/66

17. Sepsis Audit Tool

18. Sepsis Audit Tool

19. What is the TOP SIRS Infection Organ Dysfunction HR 118 @ 1527
WBC 1629
Infection RN
Organ Dysfunction
Lactate 1603

20. What would you do next? Implement the Nursing Protocol Call physician
Draw blood cultures
Draw initial lactate
Draw repeat lactate
Call physician
Anticipate order for IV Broad Spectrum Abx

21. Questions? Summer Gupta, RN, MSN 424.259.8534 X 98534
Thank you
Questions? Summer Gupta, RN, MSN X 98534