Sepsis

Sepsis guidelines are constantly changing. Refer to your national guidelines or institutional protocol for most up to date treatment information.

Introduction

  • Sepsis is bad and needs to be treated aggressively
  • Confusion around multiple conflicting guidelines and requirements
    • Surviving Sepsis Campaign recommendations
    • CMS requirements
    • Sepsis-3
    • SOFA/SIRS/qSOFA
    • Institutional protocols

Sepsis-3 Proposed Recommendations

  • Screen for sepsis by applying qSOFA instead of SIRS criteria
    • qSOFA criteria
      • Altered mental status
      • Tachypnea
      • Hypotension
    • SIRS criteria
      • Tachycardia
      • Tachypnea
      • Leukocytosis
      • Hyper/hypothermia
    • qSOFA criteria miss cases of sepsis (too specific)
    • SIRS calls everything “sepsis” even if the patient is fine (too sensitive)
  • Change definition of “Sepsis” (no more SIRS plus source)
    • New definition
      • Source of infection
      • PLUS
      • Organ disfunction
        • Determined by SOFA score (different purpose than qSOFA)
  • Eliminate the term “severe sepsis” completely
  • Redefine “septic shock”
    • Persistent hypotension
    • OR
    • Lactic acid >4

Current Approach to Sepsis

  • Step 1- If the patient has SIRS plus source
    • Get labs including a lactic acid
  • Step 2- If the patient has organ dysfunction
    • Diagnose sepsis
  • Step 3- If the patient has sepsis
    • Order broad spectrum antibiotics
    • Order blood cultures
    • Needs to be completed in <3 hours
  • Step 4- If the patient has persistent hypotension or lactate >4
    • Diagnose septic shock
  • Step 5- If they have septic shock
    • Give 30ml/kg crystalloid bolus
    • Start vasopressers if hypotension doesn’t improve with bolus

Additional Reading

  • CMS Sepsis Core Measures (ACEP)
  • Sepsis-3 Recommendations (EMJ)
  • Surviving Sepsis Campaign (SCCM)

1 Comment

  1. Entessar

    Thank you so much 🙂 that’s was helpful

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

© 2020 EM Clerkship, LLC

Theme by Anders NorenUp ↑