Transcript Branding in the Digital Age

Judy Bedard RN, MSN/ED
Addressing Hospital Quality
Initiatives through
Simulation Based Training
Disclosure
I do not have any affiliation with
Laerdal Corporation that offers
financial support for this
educational activity.
Session Overview
• Review of Sepsis, Severe Sepsis
and Septic Shock
• SIRC
• Surviving Sepsis Campaign
• Application of Simulation and Use
of Software
Objectives
• Describe the difference between sepsis, severe
sepsis and septic shock
• Identify the signs and symptoms of SIRS
• Discuss assessment finding correlated with patients
who are at increased risk for sepsis (index of
suspicion)
• Identify signs and symptoms of tissue hypoxia
• Identify signs and symptoms of organ dysfunction
• Discuss fluid resuscitation recommendations and
goals according to the surviving sepsis campaign
guidelines
• Identify correct early identification and treatment
according to the surviving sepsis campaign
guidelines
Foundation
•
Sepsis: Type of blood infection
– When the body is unable to contain the infection within the
original site and spreads into the blood
– Primarily bacterial, can be fungi or viruses
– Only 30 to 50% of patients have + blood cultures
(Chamberlain)
•
Severe Sepsis: Infection induced organ dysfunction, can be
due to hypoperfusion
– Most common type: Nosocomial pheumonia
•
Septic Shock: Hypotensive condition resulting from
uncontrolled sepsis despite fluid resuscitation, including
hypoperfusion abnormalities.
– Signs and Symptoms:
• Hypotension, tachycardia, confusion or decreased mental
awareness, requires respiratory support
– Shock develops in 40% of septic patients
Severity of Sepsis
Sepsis
• Most common form of shock treated by
Intensivists in ICU
• Most common cause of morality in ICU
• It is the 10th most common cause of death
overall
• Average Mortality:
– 20% for sepsis
– 40% for severe sepsis
– Greater than 60% for septic shock
DEFINITIONS
SIRC
Sepsis
Severe
Sepsis
Septic
Shock
• Systemic Inflammatory Response Syndrome. A physiologic
response of the endocrine axis and immune systems
• SIRS + a documented infection site
• Sepsis with organ dysfunction, hypoperfusion
abnormalities OR hypotension
• Sepsis induced hypotension despite fluid
resuscitation plus hypoperfusion abnormalities
Critical Care Medicine
SIRC: Signs and Symptoms
Patient presents with two or more of the
following criteria:
• Temperature > 38ºC or < 36ºC
• Heart Rate > 90 bbm
• Respiration:
– > 20/min
– PaCO2 < 32 mm Hg
• Leukocyte Count > 12,000/mm3, <
4,000/mm3 or > 10% immature
(band) cells
Sepsis Index of Suspicion
•Extremes of age (<10 years and >70 years )
• Primary diseases
–
–
–
–
–
–
–
–
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Liver cirrhosis
Alcoholism
Diabetes mellitus
Cardiopulmonary diseases
Solid malignancy
Hematologic malignancy
Major surgery, trauma, burns
Invasive procedures
Recent or prolonged hospitalization
Prior antibiotic therapy
Sepsis Index of Suspicion continued
– Other factors such as childbirth, abortion,
and malnutrition
– Neutropenia
– Immunosuppressive therapy
– Corticosteroid therapy
– Intravenous drug abuse
– Compliment deficiencies
– Absence of spleen
Tissue Hypoxia
•
•
•
Hypoxia – results in organ dysfunction, due to tissue
hypoperfusion
Clinical Manifestations:
• PaO2/FiO2 < 80
•
lactates (> or equal to 4 mmol/l)
• Urine output < 0.5 ml/kg/hr post fluid resuscitation
• Acute mental status alteration - confusion
• Hypotension as demonstrated by systolic BP < 90mmHg or
a reduction in systolic BP of at least 40mmHg from baseline
Treatment:
– Fluid boluses – 2 liters initially
– Pressors
» Norepi and vasopressin
» Keep CVP > 8-12 nonventilated patient
» Ventilate patient if support needed. Keep CVP 12 – 15
– Volume Expanders
Organ Dysfunction
• Treat hypoxia
• Treat hypotension
• Identify source of infection
– Antibiotics
• Fluid resuscitation, volume expanders
• Check blood panels – esp for glucose
control and lactate
• Ventilation support - ARDS
• Consider steroids
• Sedate if needed
Surviving Sepsis Campaign
•
•
•
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Early Identification and Treatment
Rapid Screening: Criteria
– Sepsis Timeline
Goal Directed Therapy
Protocols and Bundles
Therapy
• Antibiotics
• Fluid Therapy
• Lactate / hypotension
• Steroids
• Glucose Control
• Human Activated Protein C
• Blood / volume expanders
• Ventilation
• Sedation
• Renal protection
• Stress Ulcers
• DVT
Simulation
• Previously in Nursing: See One–Do One–Teach
One
• Application of Adult Learning Theories
• Simulation Advantages
– Familiarity
– Hands – on
– Retention
– Confidence
– No risk
• Is this applicable for hospitals? What type of
simulation is available? What type of impact should I
expect? Is it “real”? Where do I start?
Let’s Get Started!!!
Hands-on Time
&
Demonstration
With
Discussion!!
REFERENCES
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American College of Chest Physicians (200) Society of Critical
Care Medicine Conference. Critical Care Medicine, 20, 864-875.
Chamberlain, N. (2004). From Systemic Inflammatory Response
Syndrome (SIRC) to Bacterial Sepsis with Shock. ATSU website.
Dellinger, R., Carlet, J., Masur, H., Gerlach, H., Calandra, T.,
Cohen, J., Gea-Banaclothe, J., Keh, D., Marshall, J., Parker, M.,
Ramsay, G., Zimmerman, J., Vincent, J., Levy, M. (2004).
Surviving Sepsis Campaign guidelines for management of severe
sepsis and septic shock. Critical Care Medicine, 32 (3), 858873.
Golden, Jr., E. (2007). Sepsis: Putting the Pieces Together.
Institute for Healthcare Improvement (IHI) website.
Lindquist, F., Berry, D., Weiche, R., Brooks, S., Meyer, D.,
Campbell, M., Stermer, B., Bufton, M. (2009). Early Goal
Directed Therapy Reduces Sepsis Complication and Mortality.
Institute for Healthcare Improvement (IHI) website.
SimSuite Presentation. (2010) Take the Shock out of Sepsis.
Laerdal website.