1 / 31

Sepsis

Sepsis. Presentation to Clinical Officers at Lewanika Hospital in Mongu Western Zambia [via Skype] February 2014 Dr Glynn Jones on behalf of OKAZHI. Goals of this presentation.

nash
Download Presentation

Sepsis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Sepsis Presentation to Clinical Officers at Lewanika Hospital in Mongu Western Zambia [via Skype] February 2014 Dr Glynn Jones on behalf of OKAZHI

  2. Goals of this presentation • At the end of this presentation participants will have an understanding of the patho - physiology of sepsis, leading to early recognition and treatment • The importance of the first 2 hours will be emphasized

  3. Definitions

  4. Infection • Is the invasion of normally sterile tissue by organisms

  5. Bacteremia • Is the presence of viable bacteria in the blood

  6. Sepsis • Is defined as the presence [probable or documented] of infection together with systemic manifestations of infection

  7. Diagnostic criteria for sepsis • Include infection [documented or suspected] and some of the following: • Temperature > 38.3 or < 36o Celsius • Heart rate > 90 beats/min or more than 2 standard deviations above normal value for age • Tachypnea, respiratory rate > 20 breaths/min • Altered mental status • Significant edema • Hyperglycemia

  8. Inflammatory variables • Leukocytosis [WBC count > 12,000 ] or leukopenia [WBC count <4000] • Plasma C reactive protein, Procalcitonin

  9. Hemodynamic variables • Arterial hypotension [systolic BP < 90 mmHg]

  10. Organ dysfunction variables • Arterial hypoxemia • Acute oliguria [urine output <0.5 ml/kg/hr for at least 2 hours despite adequate fluid resuscitation] • Coagulation abnormalities • Thrombocytopenia • Hyperbilirubinemia

  11. Tissue perfusion variables • Hyperlactatemia • Decreased capillary refill or mottling

  12. Symptoms of Malaria

  13. Meningitis

  14. Management during the first 2 hours • Recognize – Clinical diagnosis of severe sepsis or septic shock • Suspected infection • Hypotension (systolic blood pressure< • 90mmHg] and one or more of the • following: pulse> 100bpm respiratory rate >24 abnormal temperature [<36o or >38o C]

  15. Fix the physiology • Oxygen: • titrate toSpO2 90 • Fluids: • After initial bolus of 1000ml continue rapid fluids LR or NS at 20ml/kg/hr up to 60ml/kg within the first 2 hours.

  16. Treat infection • Urgent empirical antimicrobials • Antibiotics • Antimalarials • Influenza – specific antiviral if suspect influenza

  17. Identify source of infection • Use sign or symptoms to consider source • Malaria test • TB or AFB smear of sputum, if cough • CXR, Gram – stain sputum • Send blood for cultures

  18. Monitor Record • Every 30 minutes until stable then every hour • SBP pulse • Respiratory rate • SpO2 • Mental status • JVP, auscultate for crackles

  19. Check results of emergency laboratory • If hemoglobin < 7 mg/dl [Hct <20] • consider transfusion • If glucose < 3 mmol/l • then give D50 [25 – 50 ml] iv

  20. If respiratory function declining [increasing RR, falling SpO2] • Check oxygen supply • If JVP elevated and/or increasing crackles • consider fluid overload

  21. Take Home Message • Sepsis is common • Be vigilant • Recognize and intervene early • Early intervention yields results and gives the best chance of avoiding progressing down the sepsis pathway ending in multi organ failure and death.

  22. Thank you for your attention

More Related