Sepsis (main)

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)