Sepsis (Septic Shock) Prognosis Prevention TREATMENT

Sepsis (Septic Shock) Prognosis Prevention TREATMENT

TREATMENT Sepsis (Septic Shock)

• Admit in ICU
• Treat local site of infection
• Monitor hemodynamics.
• SepsisSepsis (Septic Shock) Definition Diagnosis and Pathophysiology. Read more ... » is a clinicalBird Flu Avian Influenza Diagnosis Causative Virus Signs and Symptoms With Treatment. Read more ... » syndromeMetabolic,Insulin Resistance Syndrome X Causes Symptoms. Read more ... » characterized by systemic inflammation due to infection.
• There is a continuum of severity ranging from sepsis to severe sepsis and septic shockShock Presentation Risk Factors Pathogenesis Management Treatment. Read more ... ».

Sepsis (Septic ShockShock Presentation Risk Factors Pathogenesis Management Treatment. Read more ... ») Prognosis Prevention TREATMENTBird Flu Avian Influenza Diagnosis Causative Virus Signs and Symptoms With Treatment. Read more ... »

Antimicrobial therapy in Sepsis (Septic Shock)

• Ceftriaxone 2gjday
• Ticarcillin – Clavulanate 3.1g 6 hrly
• Piperacillin – Tazobactam 3.375g 6 hrly
• Imipenem – Cilastatin 0.5g 6 hrly
• Meropenem – 19 8 hrly
• Cefepime – 2g 12 hrly
• Gentamycin, Tobramycin + any of the above Ciprofloxacin 400mg 12 hrly + Clindamycin 600mg 8 hrly
• Levofloxacin 500mg 12 hrly + Clindamycin 600mg 8 hrly
• Vancomycin 19 12 hrly for MRSA infections -(Methicillin resistant Staph aureus)
• Cefotaxime 2g 8 hrly
• Ceftriaxone 2g 12 hrly
• Covers gram positive and gram negative organisms till results of culture arrive.
• Give IV only, for at least 1 week.
• Adjust dose and drugBird Flu Avian Influenza Diagnosis Causative Virus Signs and Symptoms With Treatment. Read more ... » for renalDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... » impairment.
• Removal of source of infection – Drainage of site Removal of cathetersInstruments and Procedures- Catheters. Read more ... »; and the tip is rolled over blood — agar plate for culture.
• New catheter is put in.
• Foley’s or drainage catheter replaced.
• In nasal intubation, look for paranasal sinusitis. In neutropenia, look for red tender sites.
• Look for ulcers, ureteral obstruction, perinephric ab­scess, renal abscess.
• CT and MRI of different regions is done. Hemodynamic, respiratory and metabolic support is given.
• Oxygen therapy is given.
• Organ perfusion should be adequate.
• IV fluids for hypotensionDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... » – 1-2 litre of saline in 1-2 hours is given.
• CVP (Central venous pressure) or PWP (Pulmonary wedge pressure) should be monitored specially in refractory shock, renal or cardiacSINUS Bradycardia Bradyarrhythmia Symptoms Causes Diagnosis with Treatment. Read more ... » diseaseBird Flu Avian Influenza Diagnosis Causative Virus Signs and Symptoms With Treatment. Read more ... ».
• CVP should be 10-12 cm water.
• PWP should be 12-16 mmHg
• Urine output should be more than 30 ml per hour Diuretics like Frusemide and spirinolactone can be used.
• Maintain systolic blood pressure more than 90 mmHg and cardiac index more than 4 litre per minute/m² by volume infusion.
• Inotropic therapy – Dopamine, dobutamine Vasopressors –:
• IV vasopressin
• For adrenalAldosteronism Clinical features Causes and Treatment. Read more ... » insufficiency and if hypotension persists IV hydrocortisone 50 mg 6 hourly is given.
• Circulatory adequlcy is seen clinically by assessment of mentation, skinPerfusion, urine output, SP0₂
• Ventilator Therapy is often needed for hypoxaemia, hypercapnia, muscular failure, neurological distur­bance.
• Respiratory rate more than 30/minute means impend­ing ventricular collapse.
• Mechanical ventilation is given at this stage for ad­equate oxygenation, to divert blood from respiratory muscles, prevent aspiration, decrease afterload.
• If Hb is less than 8 mg/dl blood transfusion or RBC concentrate is given.
• For metabolic acidosis, give bicarbonate if arterial pH less than 7.2
• DIC with bleeding treated with transfusion of FFP (Fresh Frozen Plasma) and platelets.
• Acidosis and DIC is reversed only if infection treated

General Support for Sepsis (Septic Shock)

• In sepsis more than 3 days, nutritional supplementa­tion reqUired by central route.
• Prevent skin infection, DVT (Deep vein thrombosis), nosocomial infection etc.

Patient Care:

• Specimens of blood and body fluids are collected and cultured.
• Two or three consecutive blood cultures are obtained while the patient is febrile.

Critical Care for Sepsis (Septic Shock)

• Invasive hemodynamic monitoring in patients with sepsis typically reveals an elevated cardiac index, decreased systemic vascular resistance, decreased oxygen delivery to tissues, and decreases in mixed venous oxygen saturation
• Fluid resuscitation with crystalloid or colloid:
• Initial therapy with fluid bolus (at least 20 mL/kg or 2 liters of crystalloid or 300–500 mL of colloid over 30 minutes)
• Use central venous pressure (CVP) of 8–12 mm Hg (12–15 mm Hg if on mechanical ventilation) as initial target of resuscitation
• Use caution in the presence of CHF.
• Vasopressors:
• Norepinephrine or dopamine
• Low-dose dopamine for renal protection is not recommended

Other measures

• · Anti endotoxin agents
• · Anti lipid A agents
• · Anti mediator agents
• · Methyl prednisolone
• · Recombinant IL-1ra
• · Anti TNFa
• · New drug – AnticoagulantDeep Vein Thrombosis Embolizations Antiplatelet Anticoagulant Treatment Therapy. Read more ... » agent recombinant activated protein C (aPe) may be used in severe.
• sepsis or septic shock. It may improve survival but may cause serious bleeding specially if plate­let count is less than 30,000/111 or there is men­ingitis. Dose is 24 119/kg/hr for four days.

Prognosis of Sepsis (Septic Shock)

• 60% patients die in 30 days to 6 months.

Prevention of Sepsis (Septic Shock)

• · Treat sepsis early
• · Avoid invasive procedures
• · Limit use of catheters
• · Avoid indiscriminate use of antimicrobials, glu­cocorticoids
• · Control of infections.