General Approach to Treatment

The speed and appropriateness of therapy administered in the initial hours after sepsis develops influences outcome, as is the case for acute myocardial infarction and

cerebrovascular accidents.

Pertinent issues in the management of septic patients are (Fig. 82-1):

1. Early goal-directed resuscitation of septic patients during the first 6 hours after recognition.

2. Early administration of broad-spectrum anti-infective therapy.

3. Activated protein C in patients with severe sepsis and high risk of death (Acute Physiology, Age, and Chronic Health Evaluation II [APACHE II] score greater than 25).

4. Hydrocortisone for septic shock patients refractory to resuscitation and vasopressors.

Infective Shock
improved morbidn f antf mortality dMp FIGURE 82-1. Therapeutic approach to sepsis. (C&S, culture and sensitivity.)

5. Glycemic control via infusion of insulin and glucose, to maintain a glucose level less than 150 mg/dL (8.3 mmol/L).

6. Adjunctive therapies: nutrition, deep vein thrombosis (DVT) prophylaxis, stress ulcer prophylaxis, and sedation for mechanically ventilated patients.

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Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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