What is sepsis? Even the world’s experts can’t agree on what it means. Is it infection plus organ dysfunction? That’s how surviving sepsis defines it. Is it infection with a whole body inflammatory respoinse? That’s how Wikipedia defines it. Is it two or more SIRS criteria plus infection? All of these overlap in a Venn diagram that is what sepsis really is.
Take Home Points
- Modified SIRS criteria: T>100.4 or <96.8 that’s over 38 or under 36 C, HR>90, RR>20, O2sat<90%, MAP<65, newALOC. Two or more plus infection/suspected infection = sepsis
- Lactate is your buddy. Your clinical gestalt in sepsis isn’t as good as you think. Use the lactate as part of your decision making in determining severity of sepsis
- Resuscitate patients before intubating. Your patient is breathing hard (can increase venous return) and hyper-adrenergic. Take those away and your patient will become hypotensive. They may have sepsis induced cardiomyopathy. Positive pressure ventilation can cause hypotension. Be prepared for the blood pressure to crash. Before intubating, fluid resuscitate, start pressors (if needed) or at least have pressors ready.
- Beware of transient hypotension in the seemingly not sick septic patient. It may be a warning sign that your patient is heading toward a bad outcome.
- Get the right antibiotics on board early
Important stuff mentioned on this show
- Sepsis Treatment Pathway/Algorithm
- Code for 3 months of free EM:RAP ERTHANKS
- Essentials of EM Live Stream February 18, 2016 registration. This is free! Salim Rezaie, Cam Berg, Joe Bellezzo and I will be talking about TIAs, Chest Pain, Sepsis, DKA, and so much more.