Sun28November0333PM 20

A 45-year-old gentleman presents with a fever and a disseminated rash. There are no other localising symptoms. There is no history of travel or unwell contacts.

Initial examination reveals a respiratory rate of 35 breaths per minute, a heart rate of 120 beats per minute, a blood pressure of 100/70 mmHg and a temperature of 39°C. Despite appropriate initial resuscitation and management, he deteriorates, and is transferred to the high dependency unit (HDU).

Which of the following, according the Surviving Sepsis guidelines and bundles, should be initiated and implemented within the first three hours of patient presentation?

(Please select 1 option)

Administration of broad spectrum antibiotics Correct

Administration of vasopressors

Administration of inotropes

Insertion of a central venous line

Insertion of an arterial line

Explanation

The Surviving Sepsis Campaign bundles are the core of the sepsis improvement efforts. A "bundle" is a selected set of elements of care distilled from evidence-based practice guidelines that, when implemented as a group, have an effect on outcomes beyond implementing the individual elements alone. Using bundles simplifies the complex processes of the care of patients with severe sepsis.

Each hospital's sepsis protocol may be customised, but it must meet the standards created by the bundle. Enhancing reliability of these bundle elements allows teams to focus on aspects of the changes they are implementing to create a reliable system that achieves the goal of 25% reduction in mortality due to sepsis called for by the surviving sepsis campaign.

The following should be completed within three hours of patient presentation:

Measure lactate level

Obtain blood cultures prior to administration of antibiotics

Administer broad spectrum antibiotics

Administer 30 ml/kg crystalloid for hypotension or lactate =4 mmol/L.

Within six hours of patient presentation you should apply vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a mean arterial pressure (MAP) =65 mmHg. In the event of persistent arterial hypotension despite volume resuscitation (septic shock) or initial lactate =4 mmol/L (36 mg/dL):

Measure central venous pressure (CVP)

Measure central venous oxygen saturation (ScvO2).

Remeasure lactate if initial lactate was elevated.

Reference:

Surviving Sepsis Campaign. Bundles.

Answer Statistics

1

89%

2

6%

3

1%

4

5%

5

1%

Times answered: 286