1) A pt with sepsis has a 101 temp. Which is more appropriate at treating this: a cooling blanket or acetaminophen? Both are avail for fever.
2) Corticosteroids with vasopressin or Levo/Dopamine if needed longer than 6 hr. Rationale?
3) Pt has a decrease in SBP from 120s to 86 in 30 min. A/Ox4 but sleepy. Pt received 1L NS bolus in ER for SBP 80s 2 hours ago, has hx of CHF, in for pneumonia and poss sepsis, on requiring BiPap. Sepsis bundle has NOT been ordered for pt. After waking pt up SBP 110s, 1 hr later SBP 82. Pt husband reports "BP runs low". Okay to request Levo just in case or is that overthinking it too much?
You're kidding right? You're scaring me if this is not a joke. MunoRN is absolutely correct. Someone needs to do a little book learning.
Wouldn't vaso be beneficial in a sepsis pt with CHF, given its diuretic effect? If you're aggressively giving fluids, you have to be concerned with volume overload, so vaso shouldn't be out of the question, right? I'm not a RN yet (I graduate in Dec), so I could be very wrong, but this is my rationale on the septic CHF patient.
Wouldn't vaso be beneficial in a sepsis pt with CHF, given its diuretic effect? If you're aggressively giving fluids, you have to be concerned with volume overload, so vaso shouldn't be out of the question, right? I'm not a RN yet (I graduate in Dec), so I could be very wrong, but this is my rationale on the septic CHF patient.
I think you should review the MOA of vasopressin and how it effects diuresis.
Specializes in Surgery, Trauma, Medicine, Neuro ICU.
We have a standard sepsis protocol that works really well. I personally try to alllllllways avoid the use of a cooling blanket unless the patient is paralyzed and sedated. Shivering makes things worse. What you're trying to "fix" with fever control is their increased oxygen demand. If you pop them on a cooling blanket and make them shiver in addition to the fever...well, that's just that much more oxygen their body needs to shiver.
Vasopressin USED to be the second line for pressors. The new 2013 surviving sepsis guidelines say dopamine.
We use coticosteroids IF the patient is still requiring pressors and IF their cortisol level is low.
Our guidelines for fluid are 2L for everyone meeting criteria (SIRS response + hypotension (SBP
Vasopressin USED to be the second line for pressors. The new 2013 surviving sepsis guidelines say dopamine.
I don't think dopamine has replaced vasopressin, their recommendation still limits dopamine use to substituting for Norepinephrine, not to replace vasopressin.
Wouldn't vaso be beneficial in a sepsis pt with CHF, given its diuretic effect? If you're aggressively giving fluids, you have to be concerned with volume overload, so vaso shouldn't be out of the question, right? I'm not a RN yet (I graduate in Dec), so I could be very wrong, but this is my rationale on the septic CHF patient.
Good thoughts, but vasopressin's functions are to retain water and constrict blood vessels. It's also known as antidiuretic hormone, therefore it is the opposite of something you'd want to give to a CHF patient needing diuresis
First thing with sepsis is find a cause, give antibiotics, if patient is hypotension needs more than 1 liter of fluid resuscitation. Normally around 3 liters is better depending in patient weight. If the patient continues to be hypotension then you can start vasopressors and Levophed is pressor of choice with sepsis. I wouldn't treat that temp unless as previously noted if the patient was to tachycardiac and loosing fluids from perspiration or the patient was on immunosuppressive meds....this would lead that a temp of 101 would be more significant in that setting. Definitely need to watch for "shocky liver" in relation to Tylenol. I don't like vasopressin all it does is allow for a lower dose of Levophed for hypotension.....dopamine is not a good idea in sepsis setting because of increase myocardial oxygen demand because if the effects of dopamine on the heart and especially the heart rate...in the setting of fever and dopamine have a high risk of extreme tachycardia. It is very important to pan culture the patient, start antibiotics immediately and fluid resuscitation and even in heart failure the fluids are very important and if nothing else just intubate the patient because the fluids are more important.
Good thoughts, but vasopressin's functions are to retain water and constrict blood vessels. It's also known as antidiuretic hormone, therefore it is the opposite of something you'd want to give to a CHF patient needing diuresis
Good thoughts about the vasopressin but in septic patient in the acute phase diuretics are almost always contraindicated because intravascular the patient is very volume depleted already because of the leaky cappillaries and fluid leaking into the extra vascular areas. This is why the patient is so hypotensive in the acute stage.
Dodongo, APRN, NP
793 Posts
"Never use vasopressin for sepsis"
You're kidding right? You're scaring me if this is not a joke. MunoRN is absolutely correct. Someone needs to do a little book learning.