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    Ns. AGUS HARYANTO, S Kep Webinar Sepsis

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    Debby F. Handayani
    This document discusses first aid strategies for sepsis situations from crisis to control. It covers definitions of sepsis and septic shock according to new guidelines. Key first aid strategies discussed include administering appropriate antibiotics within one hour, fluid resuscitation with a 30 mL/kg crystalloid bolus within three hours, using lactate levels to guide resuscitation, achieving early source control within 6-12 hours, and restoring blood pressure with vasopressors while balancing potential adverse effects. The conclusion emphasizes the importance of comprehensive, rapid, accurate, and guideline-based management by a competent team to prevent mortality and optimize care for sepsis patients.

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    Ns. AGUS HARYANTO, S Kep Webinar Sepsis

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    Debby F. Handayani
    27 views22 pages
    This document discusses first aid strategies for sepsis situations from crisis to control. It covers definitions of sepsis and septic shock according to new guidelines. Key first aid strategies discussed include administering appropriate antibiotics within one hour, fluid resuscitation with a 30 mL/kg crystalloid bolus within three hours, using lactate levels to guide resuscitation, achieving early source control within 6-12 hours, and restoring blood pressure with vasopressors while balancing potential adverse effects. The conclusion emphasizes the importance of comprehensive, rapid, accurate, and guideline-based management by a competent team to prevent mortality and optimize care for sepsis patients.

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    This document discusses first aid strategies for sepsis situations from crisis to control. It covers definitions of sepsis and septic shock according to new guidelines. Key first aid strategies discussed include administering appropriate antibiotics within one hour, fluid resuscitation with a 30 mL/kg crystalloid bolus within three hours, using lactate levels to guide resuscitation, achieving early source control within 6-12 hours, and restoring blood pressure with vasopressors while balancing potential adverse effects. The conclusion emphasizes the importance of comprehensive, rapid, accurate, and guideline-based management by a competent team to prevent mortality and optimize care for sepsis patients.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    27 views22 pages

    Ns. AGUS HARYANTO, S Kep Webinar Sepsis

    Uploaded by

    Debby F. Handayani
    This document discusses first aid strategies for sepsis situations from crisis to control. It covers definitions of sepsis and septic shock according to new guidelines. Key first aid strategies discussed include administering appropriate antibiotics within one hour, fluid resuscitation with a 30 mL/kg crystalloid bolus within three hours, using lactate levels to guide resuscitation, achieving early source control within 6-12 hours, and restoring blood pressure with vasopressors while balancing potential adverse effects. The conclusion emphasizes the importance of comprehensive, rapid, accurate, and guideline-based management by a competent team to prevent mortality and optimize care for sepsis patients.

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    of 22

    FIRST AID STRATEGIES IN SEPSIS

    SITUATIONS : FROM CRISIS TO CONTROL

    Ns. AGUS HARYANTO, S Kep

    Disajikan pada Webinar :


    UPDATING KNOWLEDGE IN SEPSIS MANAGEMENT ,
    IMPROVE CRITICAL THINKING, SAVE MORE LIVES

    “DPD PPNI JAKARTA UTARA"


    7 Oktober 2023
    CV
    1. Personal Data
    Nama : Ns. Agus Haryanto, S Kep, SH
    TTL : Bekasi, August 9th 1977
    Alamat : Jl. KH Muchtar Tabrani, Kec. Bekasi Utara ,
    Bekasi
    e-Mail : [email protected]
    2. Riwayat Pendidikan
    - Akper RSPAD Gatot Soebroto Jakarta, tahun 1998
    - Sarjana Keperawatan & Ners, STIKes Kesosi, tahun 2006
    - Sarjana Hukum, Universitas Bhayangkara, tahun 2016
    3. Institusi : RS Rawa Lumbu Bekasi
    4. Organisasi : HIPERCCI (Ketua PP Hipercci)
    5. Others :
    - Tim Trainer/Fasilitator Pelatihan Hipercci
    - Asesor Kompetensi ICU LSP Nakes Kemenkes RI
    - Tim Trainer/Fasilitator Satgas Covid Nasional (BNPB)
    • Sepsis continues to be a major health problem worldwide and is
    associated with high mortality rates.
    • The Intensive Care Over Nations (ICON) study provided global
    epidemiologic data on 10,069 intensive care unit (ICU) patients
    and confirmed that 2,973 (29.5%) of patients had sepsis on
    admission or during their ICU stay.
    • In patients with sepsis, ICU mortality was 25.8%, and hospital
    mortality was 35.3%, which was a significantly higher mortality
    rate than in the general ICU population (ICU mortality, 16.2%;
    hospital mortality, 24.2%)
    In 2016, the Sepsis-3 committee, issued the
    following new definitions:

    • Sepsis—A life-threatening condition caused by a


    dysregulated host response to infection,
    DEFINITION resulting in organ dysfunction

    • Septic shock—Circulatory, cellular, and


    metabolic abnormalities in septic patients,
    presenting as fluid-refractory hypotension
    requiring vasopressor therapy with associated
    tissue hypoperfusion (lactate > 2 mmol/L).
    FIRST AID STRATEGIES IN SEPSIS SYOK
    Sepsis and septic shock: Guideline-based management
    Siddharth Dugar, MD, Chirag Choudhary, MD, MBA and Abhijit Duggal, MD, MPH, MSc, FACP
    Cleveland Clinic Journal of Medicine January 2020, 87 (1) 53-64; DOI: https://doi.org/10.3949/ccjm.87a.18143

    • ANTIMICROBIAL THERAPY :
    Prompt, broad-spectrum antibiotics
    • Delay in giving appropriate antibiotics is associated with a significant
    increase in mortality rate.–Appropriate antimicrobials should be
    initiated within the first hour of recognizing sepsis, after obtaining
    relevant samples for culture—provided that doing so does not
    significantly delay antibiotic administration.
    FLUID RESUSCITATION
    Sepsis is associated with : vasodilation, capillary leak, and
    decreased effective circulating blood volume, reducing
    venous return.

    These hemodynamic effects lead to impaired tissue perfusion


    and organ dysfunction.

    The goals of resuscitation in sepsis and septic shock are to


    restore intravascular volume, increase oxygen delivery to
    tissues, and reverse organ dysfunction.

    A crystalloid bolus of 30 mL/kg is recommended within 3


    hours of detecting severe sepsis or septic shock.
    fluid resuscitation phases in Septic Shock :

    1 2 3 4
    Rescue: During the initial Optimization: During the Stabilization: During the De-escalation: The fourth
    minutes to hours, fluid second phase, the benefits third phase, usually 24 to phase, marked by shock
    boluses (a 1- to 2-L fluid of giving additional fluid to 48 hours after the onset of resolution and organ
    bolus of crystalloid improve cardiac output septic shock, an attempt recovery, should trigger
    solution) are required to and tissue perfusion should be made to achieve aggressive fluid removal
    reverse hypoperfusion and should be weighed against a net-neutral or a slightly strategies.
    shock potential harms negative fluid balance
    Assess volume with Passive Leg Raising test

    Tehnik Menilai Respon Cairan : Passive Leg


    Raising Test
    • Menilai pasien sepsis apakah responsif
    atau non responsif
    • Jika stroke volume atau tekanan nadi
    meningkat > 10% , maka dianggap
    responsif
    • Menilai apakah Cardiac Output dapat
    meningkat dengan pemberian volume
    • Lactate-guided resuscitation can
    significantly lessen the high mortality rate
    associated with elevated lactate levels (> 4
    mmol/L).

    Lactate level • A rise in lactate during sepsis can be due


    as a to tissue hypoxia, accelerated glycolysis
    from a hyperadrenergic state, medications
    resuscitation (epinephrine, beta-2 agonists), or liver
    guide failure.

    • Measuring the lactate level is an objective


    way to assess response to resuscitation
    EARLY SOURCE CONTROL

    Source control is imperative in managing sepsis and septic shock.

    Inadequate source control may lead to worsening organ function and


    hemodynamic instability despite appropriate resuscitative measures.

    If appropriate, source control should be achieved within 6 to 12 hours


    of diagnosis, once initial resuscitation is completed.
    • Vasopressors and inotropes restore oxygen delivery to
    tissues by increasing arterial pressure and cardiac output
    respectively.
    RESTORING • Mean arterial pressure is the preferred blood pressure to
    BLOOD target during resuscitation. The recommended initial goal
    is 65 mm Hg.
    PRESSURE • That critical threshold can vary between organ systems and
    individuals, and the target can later be personalized based
    on global and regional perfusion as assessed with urine
    output, mental status, or lactate clearance.
    • Decisions to titrate vasopressors to achieve mean arterial
    pressure goals should be balanced against potential
    adverse effects, including arrhythmias, cardiovascular
    events, and ischemia.
    KESIMPULAN
    • Pertolongan pertama yang cepat pada pasien dengan syok sepsis
    sangat menentukan keberhasilan dalam penyelamatan pasien.
    • Penanganan pasien sepsis / syok sepsis merupakan upaya secara
    komprehesif, cepat, tepat dan akurat yang didukung oleh tim work
    yang kompeten sesuai dengan Guideline penanganan sepsis terbaru :
    SSC.
    • Setiap tim yang terlibat : tenaga medis dan perawat harus memahami
    bagaimana penanganan/pertolongan pertama pada pasien
    Sepsis/syok sepsis guna mencegah mortalitas pasien dan
    mengoptimalkan asuhan dan penanganan pada pasien sepsis/syok
    sepsis.
    TERIMA KASIH

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