Sepsis (main): Difference between revisions

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==Indication==
==Indication==
Indication = Severe Sepsis
Indication = Severe Sepsis


Presumed infection with SBP <90 and two or more SIRS criteria (below)
Presumed infection with SBP <90 and two or more SIRS criteria (below):
 
#temp >38 or <36
-temp >38 or <36
#RR >20 or PaCO2 <32mmHg
 
#HR >90
-RR >20 or PaCO2 <32mmHg
#WBC >12k, <4k, or >10% bands
 
-HR >90
 
-WBC >12k, <4k, or >10% bands
 


==Treatment==
==Treatment==
 
# Airway/O2/ET
 
# Fluid resucitation (avg 5L in first 6hrs) (CVP 8-12mmHg or 12-16 intubated) (UOP 0.5-1mL/kg/hr)
1) Airway/O2/ET
# Vasopressors (SBP <70)
 
##Norepinephrine (5-20mcg/min)
2) Fluid resucitation (avg 5L in first 6hrs) (CVP 8-12mmHg or 12-16 intubated) (UOP 0.5-1mL/kg/hr)
###(consider 0.01 units/min gtt adjunct)
 
##Dopamine (5-20mcg/kg/min)
3) Vasopressors (SBP <70)
# Abx
 
# Steroids
-Norepinephrine (5-20mcg/min)
##corticotropin stim
 
###(give 50mg hydrocortisone IV + ?fludrocortisone if <9cg/dL increase, or 4mg dexamethasone empirically)
(consider 0.01 units/min gtt adjunct)
# Keep Hb > 10 (consider FFP if INR >1.5; platelets if <50,000)
 
# Tight glycemic control
-Dopamine (5-20mcg/kg/min)
# Central O2 >70 (ABG)
 
4) Abx
 
5) Steroids
 
-corticotropin stim
 
(give 50mg hydrocortisone IV + ?fludrocortisone if <9cg/dL increase, or 4mg dexamethasone empirically)
 
6) Keep Hb > 10 (consider FFP if INR >1.5; platelets if <50,000)
 
7) *Tight glycemic control
 
8) Central O2 >70 (ABG)
 


==Source ==
==Source ==
2/17/06 DONALDSON (adapted from Rosen)
2/17/06 DONALDSON (adapted from Rosen)


[[Category:ID]]
[[Category:ID]]

Revision as of 05:17, 28 March 2011

Indication

Indication = Severe Sepsis

Presumed infection with SBP <90 and two or more SIRS criteria (below):

  1. temp >38 or <36
  2. RR >20 or PaCO2 <32mmHg
  3. HR >90
  4. WBC >12k, <4k, or >10% bands

Treatment

  1. Airway/O2/ET
  2. Fluid resucitation (avg 5L in first 6hrs) (CVP 8-12mmHg or 12-16 intubated) (UOP 0.5-1mL/kg/hr)
  3. Vasopressors (SBP <70)
    1. Norepinephrine (5-20mcg/min)
      1. (consider 0.01 units/min gtt adjunct)
    2. Dopamine (5-20mcg/kg/min)
  4. Abx
  5. Steroids
    1. corticotropin stim
      1. (give 50mg hydrocortisone IV + ?fludrocortisone if <9cg/dL increase, or 4mg dexamethasone empirically)
  6. Keep Hb > 10 (consider FFP if INR >1.5; platelets if <50,000)
  7. Tight glycemic control
  8. Central O2 >70 (ABG)

Source

2/17/06 DONALDSON (adapted from Rosen)

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