FIRST AID STRATEGIES IN SEPSIS

SITUATIONS : FROM CRISIS TO CONTROL

Ns. AGUS HARYANTO, S Kep

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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 : haryantoagus121@yahoo.com
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