12/12/2017. Notice. Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection.

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1 Notice All EMS presentations will be recorded (both audio and video) and available for public viewing online. By participating in EMS you consent to audio and video recording and its/their release and or publication. You have been fully informed of your consent and release prior to your participation. Prehospital Sepsis Recognition and Treatment Jack Busch, SEI Health Educator INHS Spokane County EMS Spokane County EMS SEPSIS: What is it? Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection. 1

2 What s going on? Source of infection In sepsis, this infection is typically caused by bacteria, but can also be viral or fungal. Body responds to infection with WBCs, Antibodies, and other mechanisms to attack foreign invader Sometimes, this response is overwhelming, causing a body-wide inflammatory response How common is it? Source: CDC 2017 Risk Factors for Sepsis Children Newborns Low weight/prematurity Existing illness Male Recent trauma Adults Immunosuppression Older age Renal Impairment/Cirrhosis UTIs/Indwelling Device Diabetes Anti-Rejection Meds Hospital Admission Recent trauma or surgery 2

3 Stages of Sepsis STAGE 1: Systemic Inflammatory Response Syndrome (SIRS)/Sepsis The body s response to known infection that leads to two or more of the following: Tachypnea Tachycardia Fever SIRS Criteria: (Elevated WBC count) Respiratory Rate of >20bpm Temperature >100.4 or <96.8 HR >90bpm Stages of Sepsis We can also use the Quick Sequential Organ Failure Assessment (qsofa) criteria: Acute altered mental status Systolic BP >100mmHg Respiratory Rate <20BPM Stages of Sepsis STAGE 2: Severe Sepsis SIRS criteria met Involves one or more organ systems that begin to malfunction due to inadequate blood flow Hypoperfusion STAGE 3: Septic Shock Persistent hypoperfusion despite fluid resuscitation Inability to control body function Organs begin to fail 3

4 Stages of Sepsis What do we look for? MOST COMMON NON-INVASIVE SIGN OF SEPSIS IS ALTERED MENTATION General Assessment Identification of an infection site significantly increases your suspicion for sepsis; look during the exam. The respiratory system is the most common location of infection in the septic patient. Inspect bedridden patients for pressure ulcers or other open wounds and diabetics for wounds on their legs and feet. Assess for the presence of pulmonary, genitourinary, gastrointestinal or musculoskeletal infections. Assess any indwelling devices for indications of infection such as redness and irritation around the insertion site or pus in urine. 4

5 General Assessment Patients with sepsis may or may not present with fever. This may seem counterintuitive. Patients may experience chills or shivering as they try to compensate for the loss of heat. Patients progressing from sepsis to severe sepsis become profoundly dehydrated. Assess for signs of dehydration such as poor skin turgor, dry mucus membranes and decreased urine output. How to treat suspected sepsis BLS Interventions Always follow local protocol O2 100% Supplemental via appropriate delivery device Early hospital warning and rapid transport Monitor VS ALS Rendezvous or air evac Maintain body temp Obtain Temp and BGL Obtain suspected or known infection source How to treat suspected sepsis ALS/ILS Interventions Always follow local protocol Establish two large bore IV or IO ( cc bolus titrated to BP) Obtain full lab draw (Blood cultures if available) EtCO2 w/waveform or POC Lactate (if available) Consider pressors Dopamine or Norepi Airway management Cardiac Monitor and 12-Lead 5

6 How to treat suspected sepsis ED Treatment (Attempting to find source and kill it) Blood Cultures Arterial Lactate, CBC, Coagulation studies, Blood Gas, Chem panel Pressors/Fluid Resuscitation Blood Transfusion Antibiotic Therapy Airway Management What s on the horizon for EMS? Sepsis Alerts now common in many systems Broad-spectrum antibiotic administration Greenville Health System in SC Implemented protocol which reduced time of antibiotic administration by over an hour. (Early Antibiotic Therapy is associated with more favorable outcomes 8% increase in mortality per hour without antibiotics) Decreased admission time for patients, leading to savings of nearly $1M in the first year for the hospital participating in the study. Community Paramedicine Fill in where in-home health is unable to 6

7 Questions? Spokane County EMS Post Test 1. Which patient is most likely to be septic based on their vitals? a) 78M, HR 103, BP 104/74, RR 16, TEMP 99.4F b) 02F, HR 140, BP 92/50, RR 28, TEMP 99.0F c) 64F, HR 124, BP 100/72, RR 30, 100.6F d) 80M, HR 98, BP 116/80, RR 26, 98.9F Post Test 2. What is the most common non-invasive sign of sepsis? a) Low BP b) Altered Mentation c) Tachypnea d) Known antibiotic resistance 7

8 Post Test 3. TRUE OR FALSE: Sepsis occurs when chemicals released into the bloodstream to fight an infection trigger inflammatory responses throughout the body. a) True b) False 4. Severe sepsis is usually rated with antibiotics and. a) Steroids b) Opioids c) Anti-emetics d) IV Fluids Post Test 5. Infections which lead to sepsis and/or severe sepsis can be: Post Test a) Bacterial, fungal or viral b) only bacterial c) only viral d) Either bacterial or viral 8

9 Special thanks to Sheila Crow Stitchin Dreams Embroidery For providing our Secret Question prize Secret Question Winners Were you the first to answer tonight s Secret Question? Get your prize! If so, please healthtraining@inhs.org with your name and sponsoring agency address. We would like to feature you and your agency in next months presentation, so please also send in anything you would like to share about your organization including upcoming events, recent calls, employment opportunities, etc. Rosters & Certificates All EMS Live@Nite materials including roster, handouts and certificates are available on the following INHS Health Training website: LiveatNite-Courses/ Please fax or documents to or healthtraining@inhs.org. 9

10 Thank Thank You You 10