Download Free Medical Identification and Management of Sepsis in the Prehospital Environment PowerPoint Presentation

Identification and Management of Sepsis in the Prehospital Environment PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical titled "Identification and Management of Sepsis in the Prehospital Environment" by Dr. V.Shanthi.

This medical talks about Sepsis, a potentially life-threatening condition that occurs when the bodys immune response to an infection becomes dysregulated, leading to widespread inflammation and organ dysfunction. Early identification and management of sepsis is critical for improving outcomes, and this includes identification and management in the prehospital environment.

Tags : Sepsis, inflammation, organ dysfunction, Emergency Medicine, Emergency Medicine

Published on : Apr 14, 2023 | Views : 664 | Downloads : 1

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Identification and Management of Sepsis in the Prehospital Environment
Slide 2-

Objectives
Slide 3-

ppt slide no 3 content not found
Slide 4-

“Sepsis is caused when the body’s immune system becomes overactive in response to an infection, causing inflammation which can affect how well other tissues and organs work.” –National Institute for Health and Care Excellence Guidelines
Slide 5-

Defining Sepsis Sepsis is a syndrome A group of body dysfunctions found together Dysfunctions that progress together in a predictable way High mortality rate, variable clinical presentations
Slide 6-

ppt slide no 6 content not found
Slide 7-

Sepsis Mortality
Slide 8-

Sepsis Spectrum MORTALITY
Slide 9-

ppt slide no 9 content not found
Slide 10-

Normal Response to Infection Local infection Non-specific inflammatory response 3 phases Vasodilation - increased blood flow to site, infusion of antibodies and cells to fight infection Vessel permeability - antibodies and cells exit bloodstream and enter infected tissue Once infection is controlled, tissue repairs itself
Slide 11-

Pathophysiology of Sepsis Uncontrolled, exaggerated immune response Endothelium damage, cell mediator activation, disruption of coagulation system homeostasis Vasodilation and capillary permeability Systemic inflammatory response End-organ damage, death
Slide 12-

ppt slide no 12 content not found
Slide 13-

SIRS Systemic Inflammatory Response Syndrome A constellation of abnormal signs Many triggers, infection is most common EMS uses a version of SIRS that doesn’t rely on blood test results (WBC count, ABG) Temp, HR, RR, glucose, mental status
Slide 14-

Risk Factors for Sepsis Extremes of age (old and young) Can’t communicate, need careful assessment Patients with developmental delay Cerebral Palsy Recent surgery, invasive procedure, illness, childbirth/pregnancy termination/miscarriage Reduced immunity
Slide 15-

Increased Risk for Sepsis DIABETES, DIABETES, DIABETES Liver cirrhosis Autoimmune diseases (lupus, rheumatoid arthritis) HIV/AIDS Para/quadriplegics Sickle cell disease Splenectomy patients Compromised skin (chronic wounds, burns, ulcers)
Slide 16-

Increased Risk for Sepsis Chemotherapy Post-organ transplant (bone marrow, solid organ) Chronic steroid use Recent antibiotic use Indwelling catheters of any kind (dialysis, Foley, IV, PICC, PEG tubes, etc)
Slide 17-

Signs/Symptoms of Sepsis Symptoms of sepsis are often nonspecific and include the following: Fever = most common (elderly patients often do NOT mount a febrile response) Flu-like symptoms Chills/shaking (mistaken for seizure) Nausea/vomiting Mental status changes/fatigue/lethargy Patient often does NOT appear acutely ill
Slide 18-

Multiple Organ System Dysfunction Cardiovascular Tachycardia Hypotension Renal Oliguria Anuria Renal failure Hematologic Consumptive coagulopathy Petechiae Purpura CNS Altered mental status Respiratory Tachypnea Hypoxia Hepatic Jaundice Liver inflammation Coagulopathy Metabolic Lactic acidosis
Slide 19-

Causes of Sepsis
Slide 20-

United Effort to Improve Survival from Sepsis Research from past 20 years is saving lives Rapid identification, fluids, antibiotics Education to all physicians, nurses, technicians “Care bundles” monitored by Feds Sepsis alert teams in hospitals Chart review Administrative support at all levels
Slide 21-

(Crit Care Med 2006;34[6]:1589.)
Slide 22-

EMS and Sepsis
Slide 23-

Emerg Med J. 2009 “In time critical conditions such as AMI or stroke, specific interventions by prehospital practitioners make a significant difference to mortality.”
Slide 24-

ppt slide no 24 content not found
Slide 25-

45,394 EMS encounters in King County, Washington 1350 met criteria for severe sepsis Administration of prehospital fluid was associated with decreased odds of hospital mortality
Slide 26-

34% of patients presenting to the ED with a serious infection arrived by EMS In these patients, mortality was higher for EMS patients (8%) than non-EMS patients (2%) EMS cares for the “sickest” sepsis patients
Slide 27-

Compared severe sepsis patients arriving by EMS to those that did not 35 minute reduction to initiation of antibiotics 41 minute reduction to targeted sepsis resuscitation
Slide 28-

ppt slide no 28 content not found
Slide 29-

EMS Role in Sepsis Decreased time to intravenous fluids Decreased time to antibiotics Decreased mortality Shorter hospital stay
Slide 30-

Identifying the Sepsis Patient Look for and ask about infection Did you look at all the skin??? Look for and ask about risk factors for infection Check a temperature accurately > 38°C (100.4°F) < 36°C (96°F) more dangerous
Slide 31-

Identifying the Sepsis Patient Look for SIRS criteria in the vital signs Look for shock/dehydration Check end-tidal CO2
Slide 32-

Treating the Sepsis Patient Airway/breathing Get sats > 92% NRB, CPAP, invasive airway Circulation 2 large bore IV, consider IO 20 cc/kg NS bolus May repeat if lungs remain clear
Slide 33-

Sepsis Alert Communicate your suspicion early! It doesn’t matter if accepting facility has a formal sepsis alert response process Explicitly communicate abnormal vitals (especially temp) just as you would in trauma
Slide 34-

ppt slide no 34 content not found
Slide 35-

ppt slide no 35 content not found
Slide 36-

ppt slide no 36 content not found
Slide 37-

ppt slide no 37 content not found
Slide 38-

ppt slide no 38 content not found
Slide 39-

ppt slide no 39 content not found
Slide 40-

What about Dopamine? Dopamine traditionally used for shock in EMS Studies show that survival is worse when dopamine is used to treat septic shock Probably better to stick with fluids and rapid transport Hospitals and other EMS use norepinephrine for best survival in septic shock
Slide 41-

Respiratory Component of Sepsis Mismatch of oxygen availability to changing needs of organs (ie. Increased oxygen demand) Keep sats ≥ 92 % (NRB, CPAP, intubation) Respiratory failure can happen quickly Acute Respiratory Distress Syndrome
Slide 42-

Severe Sepsis/Septic Shock A story of imbalance… Oxygen Consumption Oxygen Delivery As sepsis progresses, circulatory abnormalities lead to an imbalance of systemic oxygen delivery and demand, resulting in global tissue hypoxia. Global tissue hypoxia is a key development preceding multi-organ failure and death.
Slide 43-

Sepsis Pitfalls Beta blockers block tachycardia response Altered mentation not recognized as “end-organ failure” Temperatures not checked EtCO2 not checked or recognized Discouragement due to hospital response
Slide 44-

EtCO2 and Lactate Low EtCO2 associated with high lactic acid Low EtCO2 predicts mortality EtCO2 of 25 mmHg = lactate up to 6.1 mm/L
Slide 45-

Identification and Management of Sepsis in the Prehospital Environment
Slide 46-

THANK YOU Presenter Name | Title presentersemail@azdhs.gov | 602-542-1025 azhealth.gov @azdhs facebook.com/azdhs