SEPSIS

LOOK FOR (1)

Confusion/tachypnoea
Hypotension and/or tachycardia
Unexplained desaturation or hypercarbia
Spiking fever and rigors, or hypothermia
Unexplained metabolic acidosis
Oliguria, elevated creatinine
Thrombocytopaenia
Evidence of disseminated intravascular coagulation (DIC)
Postoperative respiratory failure
Failure to reverse

EMERGENCY MANAGEMENT (2)

Complete COVER ABCD - A SWIFT CHECK
Call for help
100% oxygen
Bolus of crystalloid 10 ml/kg IV for cardiovascular instability
Consider placing an arterial line
Consider an adrenalin infusion in adults and in children
     1mg in 100ml burette (10 mcg/ml), start at 0.15 mcg/kg/min
     Titrate to achieve a mean blood pressure >70mmHg

FURTHER MANAGEMENT (3)

Consider placing a central venous line
Aim for a CVP of greater than 8mmHg
Place a urinary catheter
Take samples for microscopy and culture of:
     Blood, urine
     Any other fluids (eg bile, pus, ascites, CSF)
Record any prior antibiotics
Give appropriate empirical antibiotics (seek advice if unsure)
Check haematology, coagulation status, biochemistry, blood gases
 

FURTHER CARE

Continue vigorous fluid resuscitation throughout
Continue the adrenaline infusion
If there is continuing instability send to ICU

NOTES:
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The figures reported here are based on an analysis of 13 of the first 4000 AIMS anaesthesia incidents. The use of the core algorithm plus the specific sub-algorithm provides a series of check lists to successfully deal with the complex, multiple and interrelating problems that sepsis patients present.
(1) Cardiorespiratory compromise presenting as desaturation (77%), hypovolaemia (46%), and hypotension (30%) were the commonest presentations.
Post operative respiratory failure requiring re-intubation was common:
     - 62% of reported incidents, 31% requiring re-intubation.
(2) Sepsis was generally reported in high risk patients:
     70% were ASA III or above:
          Diabetics
          Instrumental enteric and biliary procedures
          Immuno-compromised patients
          Instrumental urological procedures
          Intensive Care patients
          Orthopaedic infections
(3) Active infection/sepsis:
          Urological sepsis
          Gynaecological sepsis
          Biliary sepsis
          Pancreatis
          Abscesses
          Cellulitis/fasciitis