Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial...
-
Upload
beatrice-murphy -
Category
Documents
-
view
214 -
download
1
Transcript of Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial...
![Page 1: Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial support for this educational activity.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cec5503460f949b8289/html5/thumbnails/1.jpg)
Judy Bedard RN, MSN/ED
![Page 2: Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial support for this educational activity.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cec5503460f949b8289/html5/thumbnails/2.jpg)
I do not have any affiliation with Laerdal Corporation that offers
financial support for this educational activity.
![Page 3: Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial support for this educational activity.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cec5503460f949b8289/html5/thumbnails/3.jpg)
• Review of Sepsis, Severe Sepsis and Septic Shock
• SIRC• Surviving Sepsis Campaign • Application of Simulation and Use
of Software
![Page 4: Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial support for this educational activity.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cec5503460f949b8289/html5/thumbnails/4.jpg)
• 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
![Page 5: Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial support for this educational activity.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cec5503460f949b8289/html5/thumbnails/5.jpg)
• 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
![Page 6: Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial support for this educational activity.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cec5503460f949b8289/html5/thumbnails/6.jpg)
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
![Page 7: Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial support for this educational activity.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cec5503460f949b8289/html5/thumbnails/7.jpg)
SIRC
Critical Care Medicine
![Page 8: Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial support for this educational activity.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cec5503460f949b8289/html5/thumbnails/8.jpg)
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
![Page 9: Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial support for this educational activity.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cec5503460f949b8289/html5/thumbnails/9.jpg)
•Extremes of age (<10 years and >70 years )•Primary diseases
– Liver cirrhosis– Alcoholism– Diabetes mellitus– Cardiopulmonary diseases– Solid malignancy– Hematologic malignancy– Major surgery, trauma, burns– Invasive procedures– Recent or prolonged hospitalization– Prior antibiotic therapy
![Page 10: Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial support for this educational activity.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cec5503460f949b8289/html5/thumbnails/10.jpg)
– Other factors such as childbirth, abortion, and malnutrition
– Neutropenia– Immunosuppressive therapy– Corticosteroid therapy– Intravenous drug abuse– Compliment deficiencies– Absence of spleen
![Page 11: Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial support for this educational activity.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cec5503460f949b8289/html5/thumbnails/11.jpg)
• 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
![Page 12: Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial support for this educational activity.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cec5503460f949b8289/html5/thumbnails/12.jpg)
• 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
![Page 13: Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial support for this educational activity.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cec5503460f949b8289/html5/thumbnails/13.jpg)
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
![Page 14: Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial support for this educational activity.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cec5503460f949b8289/html5/thumbnails/14.jpg)
• 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?
![Page 15: Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial support for this educational activity.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cec5503460f949b8289/html5/thumbnails/15.jpg)
Let’s Get Started!!!
Hands-on Time&
DemonstrationWith
Discussion!!
![Page 16: Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial support for this educational activity.](https://reader030.fdocuments.in/reader030/viewer/2022032722/56649cec5503460f949b8289/html5/thumbnails/16.jpg)
• 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), 858-873.
• 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.