TREATING SEPSIS

Stages ABC: Immediate Stabilization

Immediate resuscitative efforts involve maintaining patency and adequacy of the airway, and ensuring oxygenation and ventilation. Initial management of hypotension is by aggressive volume resuscitation, either with isotonic crystalloids, or in combination with colloids. Do not interfere with the heart rate: tachycardia is a compensatory maneuver.

The initial treatment priority in patients with severe sepsis is to reverse life threatening physiologic abnormalities. The airway must be controlled and the patient oxygenated and ventilated. This usually requires endotracheal intubation and commencement of mechanical ventilation. The objective of all resuscitation efforts is to maintain oxygen delivery. Indications for intubation and mechanical ventilation are: failure to protect the airway (altered mental status etc), failure to ventilate and failure to oxygenate. When in doubt, it is rarely wrong to intubate patients. In sepsis, supplemental oxygen is almost always required. Accelerated oxygen demand by respiratory muscles may cause oxygen debt and acidosis: mechanical ventilation reduces this. Care must be taken when administering anesthetic agents for gaining airway control. Many of these, propofol in particular, are potent vasodilators, and may worsen hypotension. This situation may get worse when positive pressure ventilation is applied, as the increase in interthoracic pressure will reduce venous return,

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