Sepsis Update 4

4. Sepsis Series: Steps in EGDT

1. Identify Patient: 3 things
   SIRS + documented/suspected infection + SBP below 90* or lactate >4
   
2. Activate Sepsis team: (ED and ICU)
3. Early Antibiotics (within one hour)
   
4. EGDT

• Oxygen: Supplemental or Intubated
• Insert CVP, Intra-arterial line
  
• Sedation, Paralysis (if intubated), or both
  
  
• CVP below 8, fluid bolus of 500mls every 30 mins until ≥8
• MAP below 65, vasopressor until ≥65
• ScvO2 below 70%:
  1. Hct below 30%: packed red cell until ≥30%
  2. Hct >30%: inotropes (Dobutamine) until ScvO2 ≥70%
  
  
• Admit ICU

ScvO2 of ≥70% signals EGDT being complete. If the goals are not achieved, patient is intubated and ventilated if he isn't yet.

Sepsis Series: Next Post, Sepsis Update 5, Surviving Sepsis Campaign.

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* after 20-30 cc/kg
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