Resuscitation

Sepsis

2+ = Systemic Inflammatory Response Syndrome (SIRS):

• WBC {<4 | >12}k/L
• Temp {<36 | 38}°C
• HR>90/min
• RR>20/min | paCO2<4.2kPa

+ new Infection = Sepsis

• Pneumonia
• UTI
• Peritonitis
• Meningitis
• Cellulitis / Septic arthritis / fasciitis / wound infection
• Endocarditis
• Blood stream infection

+ any new organ dysfunction = Severe Sepsis

• Acutely altered mental status
• BP {SBP<90 | MAP<65}mmHg (i.e. septic shock)
• SO2<90% on {air|O2}
• Crea>175mcmol/L or UO<0.5mL/kg/h x 2hrs
• Abnml LFT
• {Plt<100G/L | coagulopathy}
• Lactate>4 (i.e. global tissue hypoperfusion)

Apply Sepsis Care Bundle, contact outreach (Bleep 569)

• S-Lactate (yellow glucose tube - analyse within 15min)
• Blood cultures, broad spectrum Abx
• Immediate fluid 500mL over 30min (up to 3 times)
• Blood transfusion if Hb<7 or Hct<0.3
• Achieve CVP { 8-12 | if ventilated: 12-15}mmHg
• Titrate Noradrenaline to MAP>65mmHg
• If low Cardiac Output or Central Venous Oxygen Saturation ScvO2<70% despite CVP>8mmHg and MAP>65mmHg: start Dobutamine at 2mcg/kg/min
• Within 24h of presentation on ICU:
• consider Activated Protein C
• Glucose < 10mmol/L
• Tidal Volume <8mL/kg if ventilated (maintain Plateau Pressure<30cm H2O)
• Steroids if vasopressor unresponsive