1. Sepsis Are You Ready to Save a Life? By Tammy Henderson, RN, BSN Biola University 1

2. What is Sepsis? The body’s overwhelming and life threatening response to infection Can lead to: tissue damage organ failure death 2

3. 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) 3

4. 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 4

5. 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 5

6. Assessment for SIRS Vs. Simple Sepsis S.I.R.S. = Systemic inflammatory response syndrome Symptoms: Any of these Temperature >100.4F or 38C or <36C) Respirations >20 or PaCO2 <32 (metabolic acidosis) Heart rate >90 beats per minute WBC >12,000 or 10% 6

7. 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 7

8. Signs of Organ Dysfunction-What do you see? Lung Heart Kidneys Brain Skin Liver 8

9. 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). 9

10. 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) 10

11. 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) 11

12. 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 12

13. Questions? 13

14. References CDC. (2015). Retrieved March 02, 2016, from http://www.cdc.gov/sepsis/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/ 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 14