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

2. Objectives

3. 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

4. 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

6. Risk Factors

7. Screening for Sepsis

8. 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)

9. 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

10. Treatments