Septicaemia and “the sepsis six”

Patients perspective and medical management

Ling, Anita Sin YeeMohd Nazemi, Fatin Nurina | 18 March 2016

What is Septicaemia and Sepsis ?

• Blood poisoning• Sepsis : body's inflammatory reaction to a severe infection• Septicemia : the infection itself — it's defined as the bacteria

in the blood that causes sepsis.

Sepsis steps

Causes

• Most common : Bacterial infection• Can also be ; fungal, parasitic or viral infections

Symptoms :

Symptoms

SEPSIS SIX

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SIRS (Systemic Inflammatory Response Syndrome)

• Temperature > 38.5° C or < 36°C

• Heart rate > 2 SDs above normal, or bradycardia in children < 1 year old (< 10th centile for age)

• Respiratory rate > 2 SDs above normal (or pCO2 < 4.25Kpa)

• Leukocyte count > 12,000 cells/mm3 , < 4,000 cells/mm3 , or > 10% band forms

• Hyperglycaemia

• Altered mental status

• Hyperlactaemia

• Increased capillary refill time (CRT)

“Give 3” “Take 3”

Oxygen Serum Lactate

Fluid resuscitate Blood culture

IV Antibiotics Catheterise

Oxygen (O2)

Titrate O2 supplementation to saturations of 94 -98% or 88-92% in chronic lung disease

Fluid resuscitate

500ml bolus - give up to 30ml/kg

IV Antibiotics

Give IV antimicrobials according to local antimicrobial guidelines

Serum Lactate

Check lactate and full blood count

Blood Culture

Take blood cultures before giving antimicrobials

Catheterise

Assess urine output for accurate measurement in patients with severe sepsis/septic shock

3-hour bundle 1. Complete Sepsis 6 within first hour.

2. Administer a minimum of 30 mL/kg isotonic crystalloid for hypotension or lactate >4mmol/L

3. Assess patient for response to resuscitation by monitoring clinical and haemo-dynamic response, measure hourly urinary output and repeat lactate measurement.

6-hour bundle1. Apply vasopressors (for hypotension that does not respond to initial fluid

resuscitation) to maintain a mean arterial pressure (MAP) ≥ 65 mm Hg.

2. A sample fluid resuscitation algorithm is suggested as a guide to ongoing fluid resuscitation

3. Re-measure lactate as indicated.

Sepsis survivor

Relibility of the use of “sepsis six”

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