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This presentation, delivered by Dr. Glynn Jones via Skype to clinical officers at Lewanika Hospital, aims to provide a comprehensive understanding of sepsis, its pathophysiology, and the critical importance of early recognition and intervention within the first two hours of treatment. Participants will learn vital diagnostic criteria, recognize symptoms, and understand management techniques, including the administration of fluids and antibiotics, to improve patient outcomes and reduce the risk of multi-organ failure. Awareness and timely action are emphasized to combat sepsis effectively.
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Sepsis Presentation to Clinical Officers at Lewanika Hospital in Mongu Western Zambia [via Skype] February 2014 Dr Glynn Jones on behalf of OKAZHI
Goals of this presentation • At the end of this presentation participants will have an understanding of the patho - physiology of sepsis, leading to early recognition and treatment • The importance of the first 2 hours will be emphasized
Infection • Is the invasion of normally sterile tissue by organisms
Bacteremia • Is the presence of viable bacteria in the blood
Sepsis • Is defined as the presence [probable or documented] of infection together with systemic manifestations of infection
Diagnostic criteria for sepsis • Include infection [documented or suspected] and some of the following: • Temperature > 38.3 or < 36o Celsius • Heart rate > 90 beats/min or more than 2 standard deviations above normal value for age • Tachypnea, respiratory rate > 20 breaths/min • Altered mental status • Significant edema • Hyperglycemia
Inflammatory variables • Leukocytosis [WBC count > 12,000 ] or leukopenia [WBC count <4000] • Plasma C reactive protein, Procalcitonin
Hemodynamic variables • Arterial hypotension [systolic BP < 90 mmHg]
Organ dysfunction variables • Arterial hypoxemia • Acute oliguria [urine output <0.5 ml/kg/hr for at least 2 hours despite adequate fluid resuscitation] • Coagulation abnormalities • Thrombocytopenia • Hyperbilirubinemia
Tissue perfusion variables • Hyperlactatemia • Decreased capillary refill or mottling
Management during the first 2 hours • Recognize – Clinical diagnosis of severe sepsis or septic shock • Suspected infection • Hypotension (systolic blood pressure< • 90mmHg] and one or more of the • following: pulse> 100bpm respiratory rate >24 abnormal temperature [<36o or >38o C]
Fix the physiology • Oxygen: • titrate toSpO2 90 • Fluids: • After initial bolus of 1000ml continue rapid fluids LR or NS at 20ml/kg/hr up to 60ml/kg within the first 2 hours.
Treat infection • Urgent empirical antimicrobials • Antibiotics • Antimalarials • Influenza – specific antiviral if suspect influenza
Identify source of infection • Use sign or symptoms to consider source • Malaria test • TB or AFB smear of sputum, if cough • CXR, Gram – stain sputum • Send blood for cultures
Monitor Record • Every 30 minutes until stable then every hour • SBP pulse • Respiratory rate • SpO2 • Mental status • JVP, auscultate for crackles
Check results of emergency laboratory • If hemoglobin < 7 mg/dl [Hct <20] • consider transfusion • If glucose < 3 mmol/l • then give D50 [25 – 50 ml] iv
If respiratory function declining [increasing RR, falling SpO2] • Check oxygen supply • If JVP elevated and/or increasing crackles • consider fluid overload
Take Home Message • Sepsis is common • Be vigilant • Recognize and intervene early • Early intervention yields results and gives the best chance of avoiding progressing down the sepsis pathway ending in multi organ failure and death.
