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)