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Multidisciplinary Patient Care: Sepsis

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Sepsis and Septic Shock - Key take-aways:

  • Lung protection essential
  • Aggressive antibiotic therapy from earliest indication
  • Source control - what's the underlying cause?
  • Fluid and hemodynamic management vital
  • Repeat vital signs

Sepsis Bundles

Sepsis 3-Hour and 6-Hour Bundles:

TO BE COMPLETED WITHIN 3 HOURS:
1) Measure lactate level
2) Obtain blood cultures prior to administration of antibiotics
3) Administer broad spectrum antibiotics
4) Administer 30 ml/kg crystalloid for hypotension or lactate ≥4mmol/L

TO BE COMPLETED WITHIN 6 HOURS:
5) Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation)
    to maintain a mean arterial pressure (MAP) ≥65 mm Hg
6) In the event of persistent arterial hypotension despite volume resuscitation (septic shock)
    or initial lactate ≥4 mmol/L (36 mg/dL):
     - Measure central venous pressure (CVP)*
     - Measure central venous oxygen
       saturation (ScvO2)*
7) Remeasure lactate if initial lactate was elevated*

*Targets for quantitative resuscitation included in the guidelines are
CVP of ≥8 mm Hg; ScvO2 of ≥70%, and normalization of lactate.
 
 
 
ONGOING MANAGEMENT:

“After the first 6 hours, attention focuses on monitoring and support of organ function, avoidance of complications, and de-escalation of care when possible.”  New Engl J Med. 2013. 369(9):840-851.

Sepsis: Dr. Christian Becker

Sepsis
Christian D. Becker, M.D., Ph.D., F.C.C.P.
Assistant Professor
The Mount Sinai School of Medicine
Department of Medicine
Division of Pulmonary, Critical Care and Sleep Medicine 
 


 
 

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