Patient Care and Monitoring

1. Evaluate patient parameters and classify as infection, SIRS, sepsis, severe sepsis, septic shock, or MODS.

2. Review available diagnostic and laboratory data.

3. Evaluate early goal-directed resuscitation therapy. Understand what parameters define efficacy and failure of initial therapy. Recommend alternative resuscitation therapy if the patient does not respond to initial fluid challenge.

4. Evaluate the source of infection and make recommendations to remove potential source(s).

5. Analyze anti-infective therapy (dose, frequency, and duration) and revise as necessary based on clinical response and culture and sensitivity reports. Prepare an appropriate step-down therapy for the patient.

6. Determine the risk of sepsis complications and construct recommendations for treatment and monitoring.

7. Formulate appropriate doses of medications involved in patient therapy and revise as needed. Patient parameters may change frequently, thus requiring different doses and/or medications. Examples include: antibiotic therapy, sedatives, insulin, fluids, or vasopressors.

8. Continually monitor patient parameters to ensure optimal therapy to maximize outcomes.

Abbreviations Introduced in This Chapter

ADDRESS Administration of D ml re tog in Alpha in

Early Stage Severe Sepsis APACHE II Acute Physiology, Age, and Chronic Health

Evaluation II ARDS Acute respiratory distress syndrome

ARF Atute renal failure

CAP Community-acquired pneumonia

DIC Disseminated intravascular coagulation

DVT Deep vein thrombosis

ENHANCE Ex 1 ende J Evaluation of Retombinani Human

Activated Protein C MAP Mean arterial pressure

MDR Multidrug resistant

M D RSP Mult id ru g resista n i Sireptacoccus pneuttton iae MODS Multiple-organ dysfunction syndrome

MRS A, Meihitillin-resisiant Staphylococcus aureus

MSSA Melhiuiliin-sensitive aureus

PaCO, Partial pres su re of ta rb on d ioxide

PROWESS Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (study) systemic inflammatory response synd rome

SI RS Sys temic infla m matory respo n se sy n d ro m e

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