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Sepsis resuscitation bundle,[object Object]
Goal and Objectives,[object Object],Goal-,[object Object],To decrease mortality from severe sepsis in adults through education and implementation of evidenced-based care bundles,[object Object],Objectives-,[object Object],Recognize the signs and symptoms of sepsis,[object Object],Understand the difference between the types of sepsis; SIRS, sepsis, severe sepsis, and septic shock,[object Object],Learn the sepsis resuscitation care bundle,[object Object],Audience-,[object Object], Nurses,[object Object]
What is sepsis?,[object Object],Sepsis is a condition in which the body is fighting a severe infection that has spread via blood stream. This is characterized by a systemic inflammation response syndrome called, SIRS. The body may develop this inflammatory response to microbes in the blood, urine, lungs, skin, or other tissues. ,[object Object],There is a continuum to sepsis that includes infection, sepsis, severe sepsis, septic shock, and multiple organ dysfunction,[object Object]
Systemic Inflammatory Response Syndrome (SIRS),[object Object],Two or more of:,[object Object],Temperature >38˚C or <36˚C,[object Object],Heart rate >90 (unless taking beta-blocker, calcium channel blocker, or the heart is paced,[object Object],Respiratory rate >20 breaths/min or PaCO2 < 32 mmHg,[object Object],WBC >12,000 or < 4,000	,[object Object]
Types of sepsis,[object Object],Sepsis: ,[object Object],Two or more SIRS criteria, known or suspected infection,[object Object],Severe sepsis:,[object Object],Sepsis as above,[object Object],Organ dysfunction,[object Object],-hypotension: systolic <90 mmHg, MAP <65 mmHg, or a decrease in 40 mmHg from usual reading,[object Object],-Lactate > 4mmol/L,[object Object],-Altered mental status,[object Object],-Hyperglycemia in the absence of diabetes,[object Object],-Hypoxemia, O2 < 93%,[object Object],-UOP <0.5 ml/kg/hr and/or raised urea or creatinine ,[object Object],-Coaguopathy, INR >1.5,[object Object]
Sepsis Continued,[object Object],Septic shock:,[object Object],Severe sepsis,[object Object],Hypotension or raised lactate that does not improve with adequate fluid resuscitation,[object Object],Multiple organ dysfunction:,[object Object],Perfusion is compromised, ischemia and hypoxia of organs,[object Object],Cardiovascular-Heart Failure, Neurological- change in LOC, Pulmonary-ARDS, Renal- Acute Renal Failure, Metabolic-acidosis, Hepatic- Liver Failure, Hematologic-Disseminated Intravascular Clotting,[object Object]
Sepsis,[object Object],Identifying patients with severe sepsis in primary care, emergency departments, wards or admission units is crucial to reducing mortality,[object Object],In the severe sepsis resuscitation bundle, a time limit of six hours is given for all elements to be completed, although elements should be completed as soon as possible.,[object Object]
Sepsis Resuscitation Bundle,[object Object],Measure serum lactate,[object Object],Blood cultures obtained prior to administration of antibiotic,[object Object],From time of presentation, broad spectrum antibiotics must be administered within 3hrs of ED admission, or within 1hr of non-ED admission,[object Object],In the event that hypotension and/or serum lactate >4mmol,[object Object],		a) Deliver initial minimum of 20ml/kg of crystalloid or 	colloid equivalent.,[object Object],		b) Apply vasopressors for hypotension not responding to 	initial fluid resuscitation to maintain a MAP of ≥65mmHg.,[object Object],Consider insertion of urinary catheter (measure UOP),[object Object],If hypotension persists and serum lactate >4mmol despite fluid resuscitation achieve,[object Object],		a) CVP ≥8mmHg and,[object Object],		b) (ScvO2) of ≥70%.,[object Object]
Unfortunate Progression of Sepsis,[object Object],Decrease Oxygenation,[object Object],Cont. decrease in oxygenation,[object Object],Lower BP,[object Object],Signs,[object Object],Death,[object Object],Low BP,[object Object],Fluids,[object Object],Vasopressors,[object Object],Treatments,[object Object],Mechanical Ventilation,[object Object],Face Mask O2,[object Object]
Were Objectives Met?,[object Object],Can you recognize inflammation through signs such as redness, heat, swelling, pain and loss of function? ,[object Object],Are you aware of changes in vital signs; tachycardia, hypotension, decrease in O2, increase in respirations?,[object Object],What labs should you monitor aggressively?,[object Object],Do you have a better understanding of the need for urgent fluid resuscitation to reverse hypovolemia that has occurred from sepsis?,[object Object],Did this information help you interpret physiological observations to decrease mortality rate in adults with sepsis?,[object Object]
References,[object Object],Carter, C. (2007). Implementing the severe sepsis care bundles outside the ICU by outreach. British Association of Critical Care Nurses, Nursing in Critical Care, 12 (5), 225-230,[object Object],Peel, M. (2008). Care bundles: resuscitation of patients with severe sepsis. Nursing Standard, 23 (11), 41-46,[object Object],Simrandeep, S., Pradeep, S., Gurjit, S. (2009). Systemic inflammatory response syndrome outcome in surgical patients. Indian Journal of Surgery, 71, 206–209,[object Object]

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