Thursday, 16 September 2010

MRCP revision battle 13.5: Surviving sepsis

There has been a concerted push in recent years to improve the prognosis of patients presenting with sepsis, led by the international 'Surviving Sepsis' campaign.  But what are the key points to pick up for MRCP?

Firstly, a few definitions.

SIRS = systemic inflammatory response = 2 or more of:
  • temperature >38 or <36
  • WCC >12 or <4
  • RR>20 or pCO2 <4.3
  • pulse >90 (note this is lower than you'd probably have expected)

Sepsis is then defined as SIRS plus infection.

Severe sepsis is then defined as sepsis with evidence of organ dysfunction (hypoxia, anuria, raised lactate... so many possible options for the evidenve)

And then septic shock is defined as severe sepsis plus hypotension.

Now we know what sepsis is, what are the key messages from the surviving sepsis campaign?

  1. resuscitate
  • if hypotensive or lactate >4 give fluids
  • aim 
    • CVP 8-12mmHg
    • MAP>65
    • urine output >0.5mls/kg/hr
    • central venous O2 >70% or mixed venous >65%
  • if fluid alone not achieving goals, consider:
    • packed RBC to haematocrit >30% or
    • dobutamine infusion
  1.  =
  2. give antibiotics
  3. keep MAP >65mmHg
    1. norepinephrine 
    2. dopamine
  4. consider hydrocortisone if fluids and vasopressors aren't working
  5. consider recombinant human activated protein c 
    • if apache >25 or multiple organ failure
  6. remember DVT prophylaxis
  7. consider peptic ulceration prophylaxis

As Bugs Bunny would say, thaatts all folks... unless you fancy participating in today's war to check your recall of yesterday's topics...