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Sepsis: Therapeutic Basics

AB
Reason that identification of cases is not reliable...entry points are busier with long wait times; early findings are hard to distinguish from a lot of other problems; in the elderly, the findings can be very subtle and masked by underlying illness, screening methods suffer from low specificity
Lab criteria for sepsis...WBC (<4 or >12); specific organ function tests (liver enzymes, renal function, etc.); coagulation abnormalities (PT, PTT, fibrinogen, D-dimer, etc.)
What does lactic acid show?It's a marker of anaerobic metabolism found in sepsis
Measures to correct hypoperfusion...Volume resuscitation, packed red cells, pressors and inotropes
These are ways to monitor the success of early resuscitation...Arterial blood pressure (A-line), central venous pressure, urine output, arterial oxygen saturation, serial lactate measurements
IVF of choice for fluid resuscitation...Normal saline (LR typically a surgical intervention)
Common problem that develops due to the amount of fluid resuscitation needed...pulmonary edema
Probable need for this if pulmonary edema occurs...mechanical ventilation
Volume of fluid resuscitation is typically based on this...CVP measurements
For correction of abnormal DO2, many published guidelines suggest keeping Hct at this level...>30%
Use these if fluid resuscitation does not correct hypotension...vasopressors and inotropes
Goal of hemoglobin saturation for respiratory support...As close to 100% as possible
25-30% of the patients metabolid demands commonly arise from this...work of breathing (mechanical ventilation can relieve this)
The only agent that's been shown to be of clear benefit in sepsis...Activated protein C (expensive - $8000 per patient)


School of Practical Nursing
James Rumsey Technical Institute
Martinsburg, WV

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