Surviving Sepsis Campaign
Sepsis, SIRS, & Multiple Organ Dysfunction Syndrome
SIRS-presence of 2 or more of the following:
-Temp > 38 celsius or < 36 celsius
-HR > 90 bpm
-RR > 20 breaths/min or PaCO2/EtCO2 < 32 mmHg
-WBC > 12,000, < 4000 or > 10% bands
Sepsis = presence of infection + SIRS
Severe Sepsis = sepsis associated with organ dysfunction
Septic Shock = sepsis associated hypotension
and mental status changes
While not specifically relative to prehospital providers, please note the change in thinking regarding treatment changes related to trending changes in Serum Lactate levels.
ReplyDeleteGiven the frequency of Epinephrine use in Septic Shock patients in the ICU, such as with Epi as a vasopressor, serum latacte levels increase. This is due to the fact that epi, when administered, and endogenous epi levels, increase as a result of beta-2 agonist stimulation.
DeleteIncreasing serum lactate levels, accompanying an improving cardiac output and normalizing blood pressure is actually a sign of that the patient is getting better.
DeleteOften in Sepsis, the first notable, but overlooked sign is a slight change in mental status. Something's just not right, but it can be non-specific. Stages of sepsis can be described as warm/early and cold/late. In warm/early sepsis, patients look well-perfused due to massive vasodilation, in comparison to cold/late sepsis. This can be misleading and delay in patient diagnosis.
ReplyDeleteThese ominous signs regularly occur on med-surf floors. A slightly increased respiratory rate is often the very first objective finding in sepsis.
Delete