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Sepsis
Are You Ready to Save a Life?
By Tammy Henderson, RN, BSN
Biola University
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What is Sepsis?
The body’s overwhelming and life threatening response to infection
Can lead to:
tissue damage
organ failure
death
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Occurrence of Sepsis
Can occur after a minor infection
Anyone, anytime and anywhere
Difficult to diagnose and treat
Dangerous and can be DEADLY
Over 1 million cases occur yearly and 50% of those people will die. (CDC,2015)
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Who Gets Sepsis?
Anyone can get sepsis but risk is higher with:
weak immune
babies and very young
elderly
chronic illnesses (DM, AIDS, CA, Kidney or Liver Disease)
severe burn or wound
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Symptoms of Sepsis
S: Shivering, fever or very cold
E: Extreme pain or general discomfort (“worst pain ever!”)
P: Pale or discolored skin
S: Sleepy, difficult to wake up, confused
I: “I feel like I might die”
S: Short of breath
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Assessment for SIRS Vs. Simple Sepsis
S.I.R.S. = Systemic inflammatory response syndrome
Symptoms: Any of these
Temperature >100.4F or < 96.8F (>38C or <36C)
Respirations >20 or PaCO2 <32 (metabolic acidosis)
Heart rate >90 beats per minute
WBC >12,000 or <4,000 or Immature Bands >10%
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Simple Sepsis Vs. Severe Sepsis or Septic Shock
Any two of the symptoms of SIRS plus
a suspected or
documented infection= SEPSIS!
If there are signs of organ dysfunction: SEVERE SEPSIS
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Signs of Organ Dysfunction-What do you see?
Lung
Heart
Kidneys
Brain
Skin
Liver
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Sepsis Pathophysiology
Clotting cascades malfunction
cytokines are released from endothelial cells,
plasminogen stimulation and antithrombin-III activation take place in the
fibrinolytic system
fibrinolytic and fibrinogen substances are depleted,
and formation of clots and bleeding associated with disseminated intravascular
coagulation (DIC) occur at the same time.
increased platelet destruction
(Schulte, W., Bernhagen, J., & Bucala, R., 2013).
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Sepsis Campaign Bundles
Time is of the Essence!
Within 3 hours:
1. Measure lactate level
2. Obtain blood cultures prior to starting antibiotics
3. Administer broad spectrum antibiotics
4. Administer 30ml/kg crystalloid for hypotension or lactate > 4
(CDC 2015)
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Sepsis Campaign Bundles Continued:
Within 6 hours:
Vasopressors for hypotension not responsive to fluids (maintain map>65)
Remeasure lactate if initial was high
With persistent hypotension after volume resuscitation (septic shock) or lactate
>4 mmol/L
Measure Central Venous Pressure (CVP)
Measure Oxygen Saturation (SaO2)
(CDC, 2015)
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Target for Fluid Resuscitation: When is enough?
A target for resuscitation includes CVP > or =8
ScVO2 >70% Mixed venous oxygen saturation (SvO2)
Lactate normal (0.5-1)
UOP >0.5cc/kg/hr
HCT >30% normal 41-49% males, 36-47% females
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Questions?
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References
CDC. (2015). Retrieved March 02, 2016, from http://www.cdc.gov/sepsis/
Schulte, W., Bernhagen, J., & Bucala, R. (2013). Cytokines in Sepsis: Potent
Immunoregulators and Potential Therapeutic Targets—An Updated View.
Retrieved March 02, 2016, from
http://www.hindawi.com/journals/mi/2013/165974/
https://www.youtube.com/watch?v=Ih1drKihnsQ
(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2640913/pdf/11076718.pdf
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