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My Heart is Racing! Select Cardiac Arrhythmias and Practice Updates

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lunes, 23 de enero de 2017

Sepsis Guidelines 2017

EmergencyPedia
EmergencyPedia - January 23, 2017 - By Andrew Coggins

"The new surviving sepsis guideline is being rolled out in NSW in January 2017.
Here is a quick summary blog of ‘Sepsis 2017‘:
Summary of New Recommendations
  • A. Time to antibiotics within 60 minutes for patients with Sepsis (SOFA>=2), septic shock patients which essentially implies anyone with qSOFA and/or organ dysfunction
  • B. Lactate measurement and targeting lactate reduction in those who have an elevated as a serial marker
  • C. Blood cultures before antibiotics (unless there is going to be significant delay)
  • D. Governance – Use of ‘sepsis management programs’ (“Sepsis performance improvement programs should optimally have multi-professional representation (physicians, nurses, affiliate providers, pharmacists, respiratory therapists, dietitians, administrators) with stakeholders from all key disciplines represented in their development and implementation. Successful programs should include protocol development and implementation, targeted metrics to be evaluated, data collection, and ongoing feedback to facilitate continuous performance improvement“)
  • E. Empiric broad spectrum Antibiotic therapy for all sepsis patients (refer to local guidelines)
  • F. Procalcitonin (PCT) in the Emergency Department (ED) finally gets look in. (From an ED perspective, patients who improve quickly after first dose of antibiotics and PCT normalises – antibiotics could be potentially be stepped down – great role for the sepsis workflow in winter and flu season).
  • A possible approach to the lower risk septic patient could be to give first dose intravenous antibiotics, conduct a PCT and discharge after reassessment and period of observation with/without oral Ab if clinical improvement without raised PCT
  • G. There is no mention of C-reactive protein anywhere in document
  • H. Fluid Challenge for fluid resuscitation (rather than ‘drip‘ method)
  • What fluid? The usual crystalloids first, albumin next (NO ‘GEL’ and NO SPECIAL COLLOIDS)
  • I. Fluid Volume – up to 30ml/kg
  • J. What about Inotropes? – Norepinephrine – Vasopressin – Dobutamine OR Adrenaline in that order…
  • K. No routine use Steroids unless specific other indication(s)"