Detect and stop sepsis

Lev, MSN, RN, NP · Nov 20, 2015

I'm studying some sepsis control plans and related literature for a school project and have
some questions about a potential subset of patients.
Do patients in med-surge (or other) units develop nosocomial sepsis, or are the vast majority of cases detected
on presentation for admission (ED or otherwise)?
The three- and six-hour treatment bundles are usually discussed in the literature with regard to severe sepsis
and septic shock. Are they applied the same way to sepsisâ€ (just 2 SIRS criteria + new infection) and, how effective are they to stop progression to severe sepsis?
If sepsis is found when a patient presents for admission for some other problem, is it more likely to be severe sepsis, or is there even distribution of severity?
Thank you

I can't give you exact data. I can only answer anecdotally from experience in med-surg as well as the ER. This is for your information only and is not considered a reputable source for your assignment. You should try to find sources for the information I am sharing with you. Patient can develop sepsis from any infectious source. For example, a urinary tract infection can turn into sepsis. Pneumonia can turn into sepsis. A patient can become septic from a surgical site infection. A patient can become septic from a wound. When infections develop in the hospital, they are generally treated early on and sepsis is prevented in many cases. However, people do die from hospital acquired infections which is why they are so huge with the joint commission. In the ER, sepsis a frequent reason for admission to the ICU. These patients are unstable vital signs wise and may be intubated for airway protection. Our eMAR will give a sepsis/SIRS flag to patients experiencing signs/symptoms of SIRS/sepsis such as elevated WBCs/lactate, tachycardia, increased respiratory rate, hypotension, or fever. There is a distribution of severity of sepsis. Some are better off than others. i.e. not intubated or on vasopressors. Really depends how close they are to septic shock. For septic patients, one aspect of the "bundle" which is stressed in my ED is starting antibiotics within one hour of recognition of symptoms and certain weight based fluid resuscitation measures. I think the requirement is 30ml/kg of fluid.

combinate · Nov 22, 2015

Thank you Lev,

I'll list the continuum of sepsis: SIRS

So, if a patient is septic, do we start the 30 ml/kg fluid resuscitation (and, blood culture and lactate, Abx, 3-hr bundle)?

The 6-hour bundle states to apply vasopressors for hypotension that does not respond to initial fluid resuscitation. That is the first mention of blood pressure, but it must be implicitly required as we measure HR and RR for the SIRS determination, right? Or, is it required to measure BP when we ID or rule-out infection (the very next step anyway)? It is very strange that it is not listed explicitly because I think a patient can have an infection with normal, high, or low blood pressure. Therefore, a patient can have sepsis with normal or high blood pressure. And in that situation, do we still start the same fluid resuscitation? Still further, a CHF or renal patient may already have fluid overload; resuscitate with fluid in that case?

Lev, MSN, RN, NP · Nov 23, 2015

Well you have to look at your patient. If they have advanced HF or ESRD, you can keeping giving them fluid, but it will not fill the vascular space effectively. It's a balance. You may end up giving some fluid, but give it more slowly like 250ml/hr and may just 250 or 500ml at a time vs a liter bolus wide open. The amount of fluid you want to give also depends on the lactate level. A patient's BP can be anywhere with sepsis. However, often they are tachycardic unless well controlled on beta blockers. As the sepsis develops and gets worse, the BP starts dropping as the compensatory mechanisms fail.