the stop sepsis bundle
DESCRIPTION
The STOP Sepsis Bundle ToolkitStrategies to Timely Obviate the Progression of Sepsis in the Emergency DepartmentTRANSCRIPT
STOP Sepsis
6-hour Strategies to Timely Obviate the Progression of Sepsis
6-hour STOP Bundle
summarized by sun yaicheng http://decode-medicine.blogspot.com/
Early Goal-Directed Therapy in the Treatment of
Severe Sepsis and Septic Shock
Rivers E. N Engl J Med 2001;345:1368-77.
In-Hospital Mortality 28-Day Mortality 60-Day Mortality0%
10%
20%
30%
40%
50%
60%
46.50%49.20%
56.90%
30.50%33.30%
44.30%
STANDARD (N=133) EGDT (N=130)
SIRSTrauma
Burns
Pancreatitis
Other
BACTEREMIA
INFECTION SEPSIS Fungemia
Parasitemia
Viremia
Other
Systemic Inflammatory Response Syndrome • Temp < 36 ° C or > 38.3 ° C• HR > 90• RR > 20 or PCO2 < 32• WBC < 4K or > 12K or bands > 10%
SepsisSepsisSIRSSIRS Severe SepsisSevere Sepsis Septic ShockSeptic Shock
Bone et al. Chest 1992;101:1644
SepsisSIRS Severe Sepsis Septic Shock
Bone et al. Chest 1992;101:1644
SIRS with Infection
SepsisSIRS Severe Sepsis Septic Shock
Bone et al. Chest 1992;101:1644
Sepsis plus Organ Dysfunction• Elevated Creatinine (>2)• Elevated INR (DIC)• Altered Mental Status (GCS <12)• Elevated Lactate (>4)• Hypotension that responds to fluid
SepsisSIRS Severe Sepsis Septic Shock
Bone et al. Chest 1992;101:1644
Severe Sepsis and Hypotension• Hypotension that does NOT
respond to fluid (500 cc bolus)
Criteria to initiate the bundleSIRS plus source of
infection plus a
• SBP < 90 mmHg after a 20 mL/kg fluid bolus
• Lactate > 4 mmol/L• Organ dysfunction
SCCM 34th Critical Care Congress: Abstract 44. Presented Jan. 17,2005.
STOPSEPSIS
STOP Bundle Strategies
• Hemodynamic monitoring (CVP/ScvO2) within 2 hours
• Broad spectrum antibiotics administered within 4 hours
• EGDT achieved at 6 hours, including CVP ≧ 8 mmHg, MAP ≧65 mmHg, ScvO2 ≧70%
• Monitor for decreasing lactate; and administer steroid if on a vasopressor
Fever, general malaise, poor appetite for days
DM, HTN
70/40 mmHg, 39 ° C
CBC/DCWBC 20.0KHb 12.0Hct 36.0Platelet 30KSeg 75%Band 15%APPT 24.0PT 12.0INR 1.0ScvO2 60
BioBUN 25Creatinine 1.0Glucose 300Na 140K 4.0GOT 150GPT 100Alk-p 250CRP 20Lactate 40
Diagnosis
Liver Abscess with
Septic Shock
Next ?
What‘s the key point ?
summarized by sun yaichenghttp://decode-medicine.blogspot.com/