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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.

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Sepsis

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  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

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