Table 1 First hours of management in life-threatening infections
Time | Intervention |
|---|---|
Triage | ·Screen for SIRS with vital signs |
|  | ·Screen for source by history and physical exam |
|  | ·Evaluate for organ dysfunction by assessing vital signs and level of consciousness |
Immediate | ·Assess ABCs |
|  | ·Establish definitive airway |
|  | ·Initiate NIPPVwhile preparing for intubation unless patient is apneic |
|  | ·Lung protective ventilator strategies |
|  | ·Obtain intravenous access (central or two peripheral) |
|  | ·Begin volume resuscitation |
|  | ·Avoid hyperoxia |
1st Hour | ·Send labs including lactate and blood cultures |
|  | ·Establish source control via broad spectrum antimicrobials and/or definitive management |
|  | ·Check ABG to ensure adequate gas exchange and avoid hyperoxia |
|  | ·Check plateau pressure to avoid barotrauma |
|  | ·Consider bedside ultrasound to assess cardiac function and IVC collapse |
|  | ·Order appropriate imaging |
Does Patient Qualify for EGDT? | ·SBP < 90 mmHg after 20-30 cc/kg bolus |
|  | ·Lactate > 4 mmol/L |
1st Two Hours | ·If EGDT eligible, place CVC in torso vein, assess CVP, ScvO2 ·If persistent hypotension (MAP < 65 mmHg), place arterial line |
Two Hours | ·Repeat lactate and calculate clearance |
|  | ·Assess total volume input and urine output |
Three Hours | ·Reassess input/output; assess resuscitation goals; is patient still volume responsive? |
|  | ·Repeat labs to assess for correction of organ dysfunction |
Four to Six Hours | ·Final disposition |
|  | ·If resuscitation goals met, enter maintenance phase |
|  | ·If not met, reassess |
|  | ·Consider corticosteroids for vasopressor dependent hypotension |
|  | ·Assess need for glucose control |
Every 20-30 Minutes | ·Serial reassessment of response to resuscitation |