Goals and principles of treatment in septic shock
The treatment of patients with septic shock has the following major goals: Start adequate antibiotic therapy (proper dosage and spectrum) as early as possible. Identify the source of infection, and treat with antimicrobial therapy, surgery, or both (source control)
The UK Sepsis Trust developed the 'Sepsis Six' – a set of six tasks including oxygen, cultures, antibiotics, fluids, lactate measurement and urine output monitoring- to be instituted within one hour by non-specialist practitioners at the frontline.
Sepsis is the body's extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract.
Three therapeutic principles most substantially improve organ dysfunction and survival in sepsis: (1) early, appropriate antimicrobial therapy; (2) restoration of adequate cellular perfusion; and (3) timely source control.
Antibiotics. Treatment with antibiotics begins as soon as possible. Broad-spectrum antibiotics, which are effective against a variety of bacteria, are often used first. When blood tests results show which germ is causing the infection, the first antibiotic may get switched out for a second one.
Nonetheless, the early administration of antibiotics and intravenous fluids is considered crucial for the treatment of sepsis.
Nursing care management for patients with sepsis or septic shock involves prompt assessment and monitoring of vital signs, fluid resuscitation with intravenous fluids, timely administration of appropriate antibiotics, hemodynamic support with vasoactive medications, ensuring adequate oxygenation and respiratory support ...
NICE - the National Institute for Health and Care Excellence - urges hospital staff to treat people with life-threatening sepsis within one hour, in its quality standard. In clinical practice, this is often referred to as the 'golden hour' after diagnosis.
Interventions. Four 3-hour SSC guideline recommendations: 1) obtain blood culture before antibiotics, 2) obtain lactate level, 3) administer broad-spectrum antibiotics, and 4) administer 30 mL/kg of crystalloid fluid for hypotension (defined as mean arterial pressure (MAP) < 65) or lactate (> 4).
The following SIRS criteria were established: body temperature above 38 ° C or below 36 ° C, heart rate greater than 90 beats per minute, respiratory rate greater than 20 beats per minute or carbon dioxide partial pressure below 4.3 kPa, and neutrophilia above 12000 / mm3 or neutropenia below 4000 / mm3 with 10% or ...
IMMEDIATE EVALUATION AND MANAGEMENT Securing the airway (if indicated) and correcting hypoxemia, and establishing venous access for the early administration of fluids and antibiotics are priorities in the management of patients with sepsis and septic shock [3,4].
Treatment. If your loved one has sepsis, hospitalization is likely. Doctors will quickly try to stabilize by giving antibiotics and maintaining blood flow to organs to increase blood pressure. A respirator may also be needed to help your loved one breathe, and large amounts of IV fluids are also likely to be necessary.
The nursing process functions as a systematic guide to client-centered care with 5 sequential steps. These are assessment, diagnosis, planning, implementation, and evaluation. Assessment is the first step and involves critical thinking skills and data collection; subjective and objective.
In most cases when they see these conditions, nurses should immediately administer the qSOFA (quick sequential organ failure assessment) test to identify patients with suspected severe sepsis who are at greater risk for poorer outcomes.
Assess if the patient has positive blood culture, currently receiving antibiotics, had an examination or chest x-ray, or has a suspected infected wound. Signs of acute organ dysfunction. Assess for presence of hypotension, tachypnea, tachycardia, decreased urine output, clotting disorder, and hepatic abnormalities.
Signs suggestive of sepsis in adults
Heart rate > 90/minute. Acute confusion or decreased level of consciousness. Hyperglycemia (blood glucose > 7.7 mmol/L in patient without diabetes) Oliguria (urine output less than 0.5 mL/kg/hour)
Recommendation: In taking care of a patient with sepsis, it is imperative to re-assess hemodynamics, volume status and tissue perfusion regularly. Tip: Frequently re-assess blood pressure, heart rate, respiratory rate, temperature, urine output, and oxygen saturation.
Appropriate antimicrobials should be initiated within the first hour of recognizing sepsis, after obtaining relevant samples for culture—provided that doing so does not significantly delay antibiotic administration. The initial antimicrobial drugs should be broad-spectrum, covering all likely pathogens.