Surviving SepsisSurviving Sepsis

Michael StewartMichael StewartCT2 EMCT2 EM

SIRS + SepsisSIRS + Sepsis

Systemic Inflammatory Response Systemic Inflammatory Response Syndrome:Syndrome: Temp<36/>38.3Temp<36/>38.3 HR > 90HR > 90 RR >20 RR >20 WCC <4/>12; >10% immatureWCC <4/>12; >10% immature Acutely altered mental stateAcutely altered mental state BM > 6.6 in absence of diabetesBM > 6.6 in absence of diabetes

Sepsis: SIRS caused by infectionSepsis: SIRS caused by infection

Severe SepsisSevere Sepsis

Severe sepsis – sepsis leading to Severe sepsis – sepsis leading to organ hypoperfusion or hypotensionorgan hypoperfusion or hypotension

Septic shock – hypoperfusion Septic shock – hypoperfusion persists after adequate fluid persists after adequate fluid resuscitationresuscitation

Early Goal Directed Early Goal Directed TherapyTherapy

Fluids (CVP 8-12)Fluids (CVP 8-12) Vasopressors (MAP > 65)Vasopressors (MAP > 65) Optimise ScvOOptimise ScvO22::

Transfusion (Hct > 30%)Transfusion (Hct > 30%) Inotropes (ScvOInotropes (ScvO22 > 70%) > 70%)

Sepsis SixSepsis Six

OxygenOxygen CulturesCultures IV AntibioticsIV Antibiotics IV fluid resuscitationIV fluid resuscitation Blood tests, including LactateBlood tests, including Lactate Fluid balance monitoringFluid balance monitoring