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Identification and Management of Sepsis in the Prehospital Environment PowerPoint Presentation

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Description : Check out this medical titled "Identification and Management of Sepsis in the Prehospital Environment" by Dr. V.Shanthi.

This medical talks about Sepsis, a potentially life-threatening condition that occurs when the bodys immune response to an infection becomes dysregulated, leading to widespread inflammation and organ dysfunction. Early identification and management of sepsis is critical for improving outcomes, and this includes identification and management in the prehospital environment.

Tags : Sepsis, inflammation, organ dysfunction, Emergency Medicine, Emergency Medicine

Published on : Apr 14, 2023 | Views : 1164 | Downloads : 1

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Identification and Management of Sepsis in the Prehospital Environment
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Objectives
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“Sepsis is caused when the body’s immune system becomes overactive in response to an infection, causing inflammation which can affect how well other tissues and organs work.” –National Institute for Health and Care Excellence Guidelines
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Defining Sepsis Sepsis is a syndrome A group of body dysfunctions found together Dysfunctions that progress together in a predictable way High mortality rate, variable clinical presentations
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Sepsis Mortality
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Sepsis Spectrum MORTALITY
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Normal Response to Infection Local infection Non-specific inflammatory response 3 phases Vasodilation - increased blood flow to site, infusion of antibodies and cells to fight infection Vessel permeability - antibodies and cells exit bloodstream and enter infected tissue Once infection is controlled, tissue repairs itself
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Pathophysiology of Sepsis Uncontrolled, exaggerated immune response Endothelium damage, cell mediator activation, disruption of coagulation system homeostasis Vasodilation and capillary permeability Systemic inflammatory response End-organ damage, death
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SIRS Systemic Inflammatory Response Syndrome A constellation of abnormal signs Many triggers, infection is most common EMS uses a version of SIRS that doesn’t rely on blood test results (WBC count, ABG) Temp, HR, RR, glucose, mental status
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Risk Factors for Sepsis Extremes of age (old and young) Can’t communicate, need careful assessment Patients with developmental delay Cerebral Palsy Recent surgery, invasive procedure, illness, childbirth/pregnancy termination/miscarriage Reduced immunity
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Increased Risk for Sepsis DIABETES, DIABETES, DIABETES Liver cirrhosis Autoimmune diseases (lupus, rheumatoid arthritis) HIV/AIDS Para/quadriplegics Sickle cell disease Splenectomy patients Compromised skin (chronic wounds, burns, ulcers)
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Increased Risk for Sepsis Chemotherapy Post-organ transplant (bone marrow, solid organ) Chronic steroid use Recent antibiotic use Indwelling catheters of any kind (dialysis, Foley, IV, PICC, PEG tubes, etc)
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Signs/Symptoms of Sepsis Symptoms of sepsis are often nonspecific and include the following: Fever = most common (elderly patients often do NOT mount a febrile response) Flu-like symptoms Chills/shaking (mistaken for seizure) Nausea/vomiting Mental status changes/fatigue/lethargy Patient often does NOT appear acutely ill
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Multiple Organ System Dysfunction Cardiovascular Tachycardia Hypotension Renal Oliguria Anuria Renal failure Hematologic Consumptive coagulopathy Petechiae Purpura CNS Altered mental status Respiratory Tachypnea Hypoxia Hepatic Jaundice Liver inflammation Coagulopathy Metabolic Lactic acidosis
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Causes of Sepsis
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United Effort to Improve Survival from Sepsis Research from past 20 years is saving lives Rapid identification, fluids, antibiotics Education to all physicians, nurses, technicians “Care bundles” monitored by Feds Sepsis alert teams in hospitals Chart review Administrative support at all levels
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(Crit Care Med 2006;34[6]:1589.)
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EMS and Sepsis
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Emerg Med J. 2009 “In time critical conditions such as AMI or stroke, specific interventions by prehospital practitioners make a significant difference to mortality.”
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45,394 EMS encounters in King County, Washington 1350 met criteria for severe sepsis Administration of prehospital fluid was associated with decreased odds of hospital mortality
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34% of patients presenting to the ED with a serious infection arrived by EMS In these patients, mortality was higher for EMS patients (8%) than non-EMS patients (2%) EMS cares for the “sickest” sepsis patients
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Compared severe sepsis patients arriving by EMS to those that did not 35 minute reduction to initiation of antibiotics 41 minute reduction to targeted sepsis resuscitation
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EMS Role in Sepsis Decreased time to intravenous fluids Decreased time to antibiotics Decreased mortality Shorter hospital stay
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Identifying the Sepsis Patient Look for and ask about infection Did you look at all the skin??? Look for and ask about risk factors for infection Check a temperature accurately > 38°C (100.4°F) < 36°C (96°F) more dangerous
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Identifying the Sepsis Patient Look for SIRS criteria in the vital signs Look for shock/dehydration Check end-tidal CO2
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Treating the Sepsis Patient Airway/breathing Get sats > 92% NRB, CPAP, invasive airway Circulation 2 large bore IV, consider IO 20 cc/kg NS bolus May repeat if lungs remain clear
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Sepsis Alert Communicate your suspicion early! It doesn’t matter if accepting facility has a formal sepsis alert response process Explicitly communicate abnormal vitals (especially temp) just as you would in trauma
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What about Dopamine? Dopamine traditionally used for shock in EMS Studies show that survival is worse when dopamine is used to treat septic shock Probably better to stick with fluids and rapid transport Hospitals and other EMS use norepinephrine for best survival in septic shock
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Respiratory Component of Sepsis Mismatch of oxygen availability to changing needs of organs (ie. Increased oxygen demand) Keep sats ≥ 92 % (NRB, CPAP, intubation) Respiratory failure can happen quickly Acute Respiratory Distress Syndrome
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Severe Sepsis/Septic Shock A story of imbalance… Oxygen Consumption Oxygen Delivery As sepsis progresses, circulatory abnormalities lead to an imbalance of systemic oxygen delivery and demand, resulting in global tissue hypoxia. Global tissue hypoxia is a key development preceding multi-organ failure and death.
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Sepsis Pitfalls Beta blockers block tachycardia response Altered mentation not recognized as “end-organ failure” Temperatures not checked EtCO2 not checked or recognized Discouragement due to hospital response
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EtCO2 and Lactate Low EtCO2 associated with high lactic acid Low EtCO2 predicts mortality EtCO2 of 25 mmHg = lactate up to 6.1 mm/L
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Identification and Management of Sepsis in the Prehospital Environment
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THANK YOU Presenter Name | Title presentersemail@azdhs.gov | 602-542-1025 azhealth.gov @azdhs facebook.com/azdhs