NUR3517 critical care II

SEPSIS
By:
Kelly Rosalia Richard
Saidatul Fatihah Ashsyura binti Nazli
 Sepsis

Body extreme response to an infection causing the body to damage

its own organs and tissue (Sepsis Alliance 2017).

• It is a life threatening medical emergency.

• Almost any type of infection can lead to sepsis.
• Most common infection : Bacterial infections
 Causes of Sepsis

Aside from bacterial, viral or fungal infections, infections that more commonly
result in sepsis include infections of:

• Lungs, such as pneumonia • Bloodstream (bacteremia)

• Kidney, bladder and other • Catheter sites
parts of the urinary system • Wounds or burns
• Digestive system
 General body defense mechanisms

• The body has three lines of defense:

– Physical & Chemical Barrier
– Non-specific innate response
– Specific adaptive response
 Second line of defense
Fever helps slowing down
growth of bacteria & stimulating
defense mechanism

First defense
Third line of defense
Immune system:
Specifically target and attack
particular pathogen that get past
first two line of defense
 Those chemicals
trigger widespread Leads to blood
inflammation response clot & leaky
blood vessel. Resulted to :
Body release Impaired blood flow
immune chemical (oxygen& nutrient)
into blood to
combat infection.

Eventually lead to
Pathophysiology of Sepsis organ damage

• Kidney, lung, heart.

• Legs , arms.

Sev
ere
Sep
sis
Multiple organ
Blood pressure drop,
failure
Septic Shock Heart weakens
 Risk Factors

People with chronic medical conditions,

Adult 65 and above such as diabetes, lung disease, cancer,
and kidney disease

People with weakened immune Admission to intensive care unit

systems or longer hospital stays

Invasive devices, such as intravenous

Children younger than
catheters or breathing tubes
one year old
 A patient with sepsis might have one or more of the following:

High heart rate or low

Fever, shivering, or
blood pressure
feeling very cold

Confusion or
Signs & Shortness of breath
(Respiratory rate higher than or equal to
disorientation Symptoms 22 breaths a minute)

Extreme pain or Clammy or sweaty skin

discomfort
Management Control Infection

Achieve hemodynamic
stabilization

Modulate immune system

AIMS
Provide metabolic and organ
support
F. J.Hurtado,M.Buroni, J.Tenzi
 • MAP > 65
Goal in • CVP> 8 or 12 (intubated)
management • ,SPo2 > 70

• Lactate clearance >10%

• Urine Output > 0.5 ml/Kg/hr

 Management of Sepsis

S ou r c e C on t r o l Re su sc it a ti o n

Surviving Sepsis Campaign,2020

 Source Control

1 ) I d e n t i fi c a t i o n o f s o u r c e
• Full blood count,
 Evaluate Red blood cell and White blood cells and PLatelets
 Measure lactate level ( increase level indicate organ dysfuntion
 Blood gases – evaluate oxygen in blood and acid-base balance
• Urinalysis
 test for presence of infection such as UTI or other issues related within kidneys
• sputum cultures
 Test for presence of infection in throat or lungs
• Obtain targeted imaging
 CT scan to evaluate for any swelling or abdominal issues for example peritonitis

Surviving Sepsis Campaign,2020

 Source Control

2) Source management

• Administer broad- spectrum antibiotic towards source of infection the within 1 hour.

• Drainage (Percutaneous > Surgical ) of abscess when indicated

• Remove IV access devices if found as source.

Surviving Sepsis Campaign,2020

 Resuscitation
Fluids!
• Administer IV fluids
 Crystalloid (Hartman /
Normal Saline) @ 30 ml /kg
within 3 hours
 Albumin 100 – 200 ml of
20% albumin within 30 to 60
minutes
Start
Pressors!
• Urgent restoration of
adequate perfusion pressure
to the vital organ
• Adminitster
 Norepinephhrine as 1st line
 Dopamine or Vasopressin
as 2nd Line
Steroid
Therapy
• Not recommended to treat
septic shock if fluid or
vasopressor can maintain
MAP
• If not achievable
 Inj. Hydrocortisone
200mg/day
Surviving Sepsis Campaign,2020
In Summary ……
Surviving Sepsis Campaign,2020
 Complication

O c c u rre d i n

Patient with sepsis if it not properly treated or not

treated at all.
 Complication
Re sp ir a to r y i nf e c ti o n
Have high risk to develop respiratory
organ dysfunction
Acute respiratory distress syndrome
(ARDS).
Co a g u l op a t h y
Thrombocytopenia in 10 -30%
Platelet usually very low < 50,000/UL
in Disseminated intravascular
coagulation.
Ac ut e Br a in I n ju r y
During severe sepsis the brain is often the
first organ to fail and up to 70% of sepsis
patients experience disturbances in brain
function as a result of the immune reaction
Results to Guillain –Barre Syndrome.
Re n a l C om p li c a t io n
Oliguria
Azotemia
Protenuria. Surviving Sepsis Campaign,2020
 Re fe re n c e s

Centers for Disease Control and Prevention. (2021, January 27). What is sepsis? Centers for Disease
Control and Prevention. Retrieved from https://www.cdc.gov/sepsis/what-is-sepsis.html
Tomczak, L. (2019). The Pathophysiology of Sepsis. Nursing Student Class Projects (Formerly MSN).
389. Retrieved from https://digitalcommons.otterbein.edu/cgi/viewcontent.cgi?article=1407&context=
stu_msn
Mayo Foundation for Medical Education and Research. (2021, January 19). Sepsis. Mayo Clinic.
Retrieved from https://www.mayoclinic.org/diseases-conditions/sepsis/symptoms-causes/syc-20351214
 
U.S. National Library of Medicine. (2016, September 23). Sepsis. MedlinePlus. Retrieved from
https://medlineplus.gov/sepsis.html  
Moyle, S. et al (2020). Sepsis: Signs, Symptoms and qSOFA. Ausmed. Retrieved from
https://www.ausmed.com/cpd/articles/sepsis
THANK YOU….Question?