septic shock

« ADULT SEPSIS AND SEPTIC SHOCK: SCREENING, EARLY INTERVENTION AND RESUSCITATION • • • • • ALS 2025 REFERENCE CARD Use screening tools such as SIRS, NEWS, MEWS and qSOFA* to identify sepsis/septic shock Perform primary assessment (Airway, Breathing, Circulation, Disability, Exposure) and emergent/ initial interventions, if not already done Rapidly identify and control source of infection, if possible Obtain vascular access, clinically relevant laboratory studies, lactate and blood cultures Re-measure lactate if initial lactate is elevated > 2.0 mmol/L Consider alternative causes of elevated lactate Do not delay antimicrobials to obtain cultures Perform secondary assessment as patient condition allows Sepsis? Low likelihood High likelihood A Immediately; Ideally Within 1 Hour of Recognition • Ensure adequate airway, oxygenation, ventilation and perfusion, if not already done Consider high-flow nasal oxygen, noninvasive ventilation or invasive ventilation with low tidal volume (6 mL/kg) • If shock/hypoperfusion: Administer 30 mL/kg of balanced IV crystalloid fluid (Lactated ringers, Plasma-Lyte A); complete infusion within 3 hours • Administer broad spectrum IV antimicrobials Hypotension (MAP < 65 mmHg) despite IV fluid? YES YES Shock present? YES (sepsis suspected) NO (sepsis not suspected) Evaluate for other causes of shock Within 3 Hours of Presentation • Perform ongoing assessments • Rapidly test for infectious versus noninfectious causes of acute illness • Immediately treat for acute conditions that mimic sepsis Sepsis identified? See reverse side NO Follow appropriate code cards YES NO Go to A Continue monitoring and re-evaluate patient: Guide resuscitation with lactate level, capillary refill time and changes in dynamic measures Titrate medications and continue interventions as appropriate Antimicrobial Therapy: Timing, Dose and Duration • Initiate antimicrobial coverage based on suspected source and institutional protocols: For septic shock, administer broad spectrum IV antimicrobials immediately, ideally within 1 hour of recognition of sepsis/septic shock – For possible sepsis, administer broad spectrum IV antimicrobials within 3 hours if concern for infection persists • When using a beta-lactam antibiotic, use a prolonged infusion for maintenance after an initial bolus; use specific pharmacokinetic/dosing guidance for different drugs/drug classes – Care Note • • Rapidly identify or exclude specific diagnoses of infection and implement any required source control interventions as soon as logistically practical. Promptly remove IV access that may be source of infection after new access has been established. Antimicrobial Therapy: Guidelines For Sepsis/Septic Shock Sepsis Mimics Pulmonary embolism, diabetic ketoacidosis, adrenal insufficiency, anaphylaxis, pancreatitis, bowel obstruction, hypovolemia, vasculitis, toxin ingestion/withdrawal or medication effect. * qSOFA should not be used as a single screening tool for sepsis or septic shock. Methicillin-resistant Staphylococcus aureus (MRSA) • High risk: Use empiric antimicrobials with MRSA coverage • Low risk: Use antimicrobials without MRSA coverage Multidrug resistance (MDR) organisms • High.... »