Delirium/ Dementia

Diabetes management
Normal bs 4.0 6.0 mmol/l

Hypoglycemia BS 1.3
Give dextrose, or carbohydrate, keep checking and
increase every 15 mins until BS is above 4 mmol/l
Sepsis and Septic Shock
. Definitions systemic inflammatory response syndrome (SIRS): two or more of 1.
temperature <96.8oF/36oC or >100.4oF/38oC2. heart rate >90 beats per
minute3. respiratory rate >20 breaths per minute or PaCO2 <32 mmHg 4. WBC
<4 x 109/L or >12 x 109/L or >10% bands

sepsis: SIRS + proven or provable infection

severe sepsis: sepsis + signs of end-organ dysfunction and hypoperfusion

septic shock: severe sepsis + hypotension (<90 mmHg sBP), despite adequate
fluid resuscitation

. Pathophysiology causative agents are identi ed in only 50-70% of cases when

organisms are identified, GP and GN organisms are the cause in 90% of cases
primary bloodstream infection or secondary bacteremialocal immune
responseimmune cells release pro-in ammatory cytokinesimmune
response spreads beyond local environmentunregulated, exaggerated systemic
immune responsevasodilation and hypotensioninvolvement of tissues remote
from the site of injury/infection resulting in multiple major organ
dysfunctionperiodic immunoparalysis

. Clinical Features history: fever, chills, dyspnea, cool extremities, fatigue, malaise,
anxiety, confusion physical: abnormal vitals (fever, tachypnea, tachycardia,
hypotension), local signs of infection

. Investigations CBC, electrolytes, BUN, creatinine, liver enzymes, ABG,

lactate, INR, PTT, FDP, blood C&S x3, urinalysis, urine C&S and cultures of
any wounds or lines, CXR (other imaging depends on suspicion of focus of
infection)
Treatment respiratory support: O2 intubation cardiovascular support: IV fluids,
norepinephrine + ICU IV antibiotics (empirical, depends on suspected source)

. start with broad spectrum antibiotics (piperacillin/tazobactam or meropenem)

additional agents depending on patient risk factors, suspected etiology of
infection, and local microbial susceptibilities ( aminoglycoside for drug-resistant
GNs or vancomycin for MRSA)
. narrow once susceptibilities are known
. hydrocortisone IV in patients with septic shock unresponsive to fluid
resuscitation and vasopressors