Sepsis (main)

Indication

Indication = Severe Sepsis

Presumed infection with SBP <90 and two or more SIRS criteria (below)

-temp >38 or <36

-RR >20 or PaCO2 <32mmHg

-HR >90

-WBC >12k, <4k, or >10% bands

1) Airway/O2/ET

2) Fluid resucitation (avg 5L in first 6hrs) (CVP 8-12mmHg or 12-16 intubated) (UOP 0.5-1mL/kg/hr)

3) Vasopressors (SBP <70)

-Norepinephrine (5-20mcg/min)

(consider 0.01 units/min gtt adjunct)

-Dopamine (5-20mcg/kg/min)

4) Abx

5) Steroids

-corticotropin stim

(give 50mg hydrocortisone IV + ?fludrocortisone if <9cg/dL increase, or 4mg dexamethasone empirically)

6) Keep Hb > 10 (consider FFP if INR >1.5; platelets if <50,000)

7) *Tight glycemic control

8) Central O2 >70 (ABG)

2/17/06 DONALDSON (adapted from Rosen)