SEPSIS Bundles & Early goal directed therapy

SIRS = 2 or more of
Temp < 38.3 or < 36
WBC < 4 or > 12
Pulse > 90
Resp > 20

SIRS + Documented/suspected infection = Sepsis
Sepsis + end organ failure = Severe Sepsis
Sepsis + unresponsive hypotension = Septic Shock

2 bundles = Resuscitation Bundle in 6 hours and Management Bundle in 24 hours

Resuscitation Bundle:

1. Check Lactates
2. Blood Cultures
3. Antibiotics after culture within an hour
4. Treat Hypotension or lactatemia (> 4 mmol/L) with fluids and/or Vasopressors to keep MAP > 65
5. If persistent, CVC to be done to keep CVP > 8, and Mixed Venous Sats > 65

EGDT: Subset of resuscitation bundle:

• MAP > 65
• Mixed Venous Sat > 65 %
• CVP > 8
• Urine Output > 0.5 ml/kg/hr
• Sugars < 8.3
• Hemoglobin between 7 to 9 gm/dL

SEPSIS SIX are 6 Tasks to be completed by any ED physician staff within the first hour:

• Give High Flow Oxygen
• Obtain Blood Cultures
• IV Antibiotics
• IV Fluids
• Check Lactates
• Monitor hourly urine output

(N.B.: Consider low dose steroids if a patient with septic shock do not respond to fluid resuscitation or vasopressors and has persistent hypotension)