Ver el código de «Harbor:Sepsis core measures»

==Sepsis==
===PERFORMANCE GOALS===
*Inclusion: 
**Age 18 and older
**ICD-10 diagnosis

*Exclusion: 
**Comfort care
**Transferred from another acute care facility
**Expire within 3 hrs of severe sepsis presentation or 6 hrs of septic shock presentation
**Received IV antibiotic more than 24 hrs prior
**Documented treatment refusal

IF PATIENT TRIGGERS SEPSIS ALERT BUT IS NOT SEPTIC, DOCUMENT "Not Septic (.sepsisnotseptic)"

===DEFINITION===
Source + 2 of the following: 
*T>38 or <36
*HR >90
*RR>20
*WBC >12 or <4, or >10% bands

===ACTIONS===
*Use Sepsis Order Set
*3 hour bundle: 
**Draw initial lactate
**Obtain blood cultures prior to antibiotics
**Administer broad spectrum antibiotics targeted at source
*6 hour bundle: 
**Repeat lactate if initially 2 or greater
**Clock starts when patient meets criteria for severe sepsis or septic shock

===DOCUMENTATION===
none specific

==Severe sepsis==
===DEFINITION===
*Sepsis + acute organ dysfunction
*1 or more of the following:
**Hypotension: SBP < 90 or MAP < 65 or SBP decrease >40 
**Hypoxia: requiring oxygen
**Kidney Injury: creatinine > 2 or UOP < 0.5 ml/kg
**DIC: PLT < 100, INR > 1.5
**Hepatic dysfunction: bilirubin > 2
**Lactate > 2

===ACTIONS===
Same as sepsis

===DOCUMENTATION===
Use Severe Sepsis Assessment: (.edseveresepsis)

==Septic shock==
===DEFINITION (One of the following)===
*Severe sepsis + persistent hypotension despite 30ml/kg IVF bolus
*Lactic acid > 4

===ACTIONS===
*3 hour bundle: 
**Start 30ml/kg IVF bolus
**Currently no exclusion for fluid overload patient, but use your clinical judgement, and document accordingly.
*6 hour bundle: 
**Start vasopressors if no improvement


'''Perform “volume status & tissue perfusion assessment”'''
*Option 1: Must include all elements below
**Vital signs
**Heart exam: RRR, Irregular, S3, S4
**Lung exam: Clear, wheezes, crackles, diminished
**Pulses: 2+, 1+
**Cap Refill: <2 sec, >2 
**Skin: Mottled, not mottled, pale, pink
*Option 2: Need 2 of the following
**Central line: CVP, SCVO2
**Bedside ultrasound volume assessment
**Passive leg raise or fluid challenge
**Clock starts when patient meets criteria for severe sepsis or septic shock

===DOCUMENTATION===
(.edsepticshock)

==See Also==
*[[Harbor:Antibiotics in Sepsis]]

[[Category:Admin]]