(精选)Neutropenic Sepsis教学课件.pptVIP

Common sources of sepsis Site Respiratory 38% Urinary tract 21% Intra-abdominal 16.5% Cather Related Blood Stream Infection 2.3% Devices 1.3% CNS 0.8% Others e.g. cellulitis 11.3% Risk of Septic Shock with Neutropenia High Risk Patients Low Risk Patients Inpatient at the time of developing fever Significant medical co-morbidities or clinically unstable Anticipated prolonged severe neutropenia Hepatic insufficiency Renal insufficiency Uncontrolled/progressive cancer Pneumonia or other complex infection Mucositis grade 3-4 Outpatient at the time of developing fever No associated acute co morbid illness Anticipated short duration of neutropenia Good performance status No hepatic or renal insufficiencies Look for signs of Organ Dysfunction Look for signs of organ dysfunction ? ? ? ? ? ? ? ? ? Systolic BP 90 or Mean Arterial Pressure 65 or Systolic BP more than 40 below patient’s normal New need for oxygen to achieve saturation 90% Lactate 2 mmol/L (following administration of fluid bolus) Urine output 0.5ml/kg for 2 hours – despite adequate fluid resuscitation Acutely altered mental status Glucose 7.7 mmol/L (in the absence of diabetes) Creatinine 177 micromol/L Bilirubin 70 micromol/L PTR 1.5 or aPTT 60s Platelets 100 x 109/L Any new organ dysfunction Inform Registrar or Consultant immediately. Reassess frequently in 1st hour. Consider other investigations and management +/- source control if patient does not respond to initial therapy as evidenced by haemodynamic stabilisation then improvement. THIS IS SEVERE SEPSIS: Signs of Septic Shock Look for signs of septic shock (following administration of fluid bolus) ?Lactate 4 mmol/L Hypotensive (Systolic BP 90 or MAP 65) ? Consultant referral ? Consider transfer to a higher level of care ? Critical care consult requested A critical care consult may be requested at any point during this assessment, but is required for patients with Septic Shock. In a h