Lesson from Post for April 11

Link to surviving sepsis guidelines for April 11 discussion.  The goal of the question was to identify that the patient had sepsis and to act per surviving sepsis guidelines.

1. Identify sepsis
2. Check lactic acid (POC off ABG)
3.  Fluid resuscitate with 30 ml/kg even if the patient has heart failure - the patient is on the vent so we can oxygenate her and if she was not intubated - can easily intubate her for the initial treatment of her sepsis.  The goal is to fluid resuscitate to prevent end organ damage which results in the increased mortality of sepsis.
4.  Once the patient is fluid resuscitated, if she remains hypotensive - pick correct pressor.  Levophed is the correct 1st line agent for sepsis.  Vasopressin and epi are the second line choices to add.  Dopamine is no longer recommended (as first or second line agent) unless the patient is bradycardic as it is associated with increased tachyarrythmias.
5. Obtain cultures immediately and start antibiotics within one hour of identifying sepsis.

Doing the above in the first three hours of identifying sepsis saves lives.

I like to relate sepsis to the below statements:

To a Cardiac Patient: Time is Muscle

To a Stroke Patient: Time is Brain

To a Sepsis Patient:  Time is Survival