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SpO2 levels decreasing below patient normal value 5. Cough: either dry or productive (green, brown, yellow, bloody) 6. Chest pain that worsens with deep breath or when coughing 7. Fever, shaking, chills 8. Lab Values: Increased WBC and/or increased neutrophils 9. X-Ray 10. Organisms in sputum 11. Pt. may be pale, dusky, blue 12. Diaphoretic, loss of appetite, fatigue and (in elderly) confusion Early signs of Sepsis: (#1 killer in of Critical Care patients) 1. Suspected Infection 2. Two out of four: a. Temp>100.4, <96.8 b. HR>90 c. RR >20 or PCO2<32 d. WBC >12,000 or <4000 or 10% bands 3. SBP <90 after 20-30cc/kg fluid bolus (1.5-3 liters of fluid) 4. Elevated lactic acid ( LDH, Lactate) 5. Decreased platelets 6. Decreased PO2 below patient normal 4. Altered mental status not due to drugs may signify organ failure. Signs of Severe Sepsis: 1. Patient receiving antibiotics & needs Vasopressor (this is a dangerous sign). 2. Pt showing signs of organ failure in 2 + systems for <= 24 hrs. 3. ARDS, DIC, MSOF Criteria for Organ Failure: 1. Cardiovascular: a. SBP <= 90 b. MAP <= 70 for 1 hour or CVP >8-12 c. CK, CKMB, Troponin elevated 2. Hemodynamics: a. Platelets <80,000 b. 50% decrease in platelets over 3 days 3. Renal: a. UOP < 20cc/hour (with CVP >8-12) b. High Creatinin and BUN , GFR >29 c. Increased electrolytes (High K, Mg, and Na) d. Increased Uric Acid e. Metabolic Acidosis f. Increased BP g. Prolonged bleeding 4. Hepatic: a. Jaundice b. High AST and ALT, Biliruben, Gamma-Gt c. Decreased Albumin d. Coagulation abnormalities 5. Metabolic: a. <=7.30 b. BE >= 5 c. Lactate >2.0 once CVP> 8-12 6. Respiratory: a. PaO2/FiO2 <= 250 b. Early ABG = Respiratory Alkalosis due to high RR a. Later ABG = Metabolic Alkalosis due to low perfusion
High Risk for DIC: 1. Infection in blood (Sepsis) 2. Severe tissue injury, as in burns, head injury, trauma. 3. Recent surgery or anesthesia 4. Reaction to transfusions 5. Labor & delivery problems 6. Liver disease High Risk for ARDS: 1. Aspiration 2. Pneumonia 3. Sepsis 4. Transfusion 5. Lung contusion 6. Inhalation injury 7. Near Drowning 8. Chemical inhalation Signs of ARDS 1, SOB 2. Labored 3. Cyanosis 4. Tachypnea 5. Decreased BP (Shock) 6. Organ failure 7. Rales/ crackles (fluid) 8. ABG = Respiratory Acidosis 9. Chest X-Ray High Risk for PE: 1. Prolonged bed rest, long car car or plane rides, etc. 2. Surgery, especially pelvic 3. Child birth 4. Massive trauma 5. Cancer 6. Stroke 7. Heart attack 8. Heart surgery 9. Fracture of hip or femur Signs of PE: 1. Tachypnea: increased rate and depth. (70% of cases) 2. Rales (50% of cases) 3. ABG is normal 4. Dyspnea at rest 5. Diaphoretic 6. Chest pain occurs suddenly & may worsen with deep breath, cough, movement 7. Cough began suddenly, may be bloody sputum 8. Tachycardia (30% of cases) 9. Anxiety 10. Bluish or dusky skin 11. D-Dimer (70% false positive). 12. V/Q Scan (best indicator 87%) 13. Treatment – preventative (support ventilation, anticoagulants)