Download - TAKE HOME MESSAGE symposium1
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TAKE HOME MESSAGE
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1. WAAROM SEPSIS?
• Hoge mortaliteit
• Hoge incidentie
• Toenemende jaarlijkse incidentie
• Hoge kost
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Lung1 Colon2 Breast3 Sepsis4
cancers
Annual
UK mortality
(2003),
thousands
1,2,3 www.statistics.gov.uk,,
4Intensive Care National Audit Research Centre (2005)
0
10
20
30
40
Relative mortality
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2. SNEL herkennen
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* Nut van postercards –
educatie
* Electronische pop-up:
alarmering
* Risico stratificatie
* Snelle diagnostiek geeft
snelle therapie
Verlaagt de mortaliteit !
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3. DEFINITIES uniform
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GOEDE BLOEDDRUK ?
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4. SEPSIS CARE BUNDLE
• 3 en 6 uren bundel
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UITDAGING = VOCHTBELEID
GEEN
COLLOIDEN
CAVE
OVERVULLING !
30 ml/kg vocht
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PICCO TRIAL
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5. SCREENINGTOOL
• Klinische parameters:
– Hartfrequentie, bloeddruk, ademhalingsfrequentie
– Zuurstofsaturatie, marbratie huid, trage capillaire refill
– Shock index: hartfrequentie/systolische bloeddruk
• > 0.7: hoogrisicio
• Rekening houdend met bèta- en calciumblokkers
• Nut van alarm pop up op triage, spoedgevallen
• Nut van prehospitaal (eerstelijns, ziekenwagen)
screeningtool: voldoet de patiënt aan de
definitie van sepsis ?
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6. VERWIJZING
• Relevante voorgeschiedenis: oncologisch,
hematologisch, splenectomie?
• Co-morbiditeit: Nierfalen? Hartfalen?
Diabetes? COPD?
• Medicatiegebruik/allergie penicilline?
• Klachten, klinische bevindingen
• Reeds AB gestart?
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7. WIE = RISICO PATIENT?
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Onafhankelijke predictoren voor ICU transfert
1. RR > 20/min of sat < 90% zonder zuurstof2. Hartfaal patiënten3. Perifeer vasculair lijden4. SAP < 100mmHg op ED5. HR > 90/min6. NI *RF voor ongeplande opname op ICU: pneumonie, sepsis*Laag ScvO2 !
TREND van ScvO2 volgen
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