Sepsis is a life-threatening condition caused by a bacterial infection that causes widespread unchecked systemic inflammation that can cause end organ damage, shock & even death. When you suspect sepsis, you must act very quickly and implement a sepsis bundle all within 1 hour of time before mortality goes up, but if we can introduce the sepsis bundle guidelines within 1 hour, then sepsis mortality may decrease 20-30%. We can remember this using the letter A B C D & E. As you could see here, they're all in a bundle. And let's start with the letter A, Acid lactic acid that is, a marker greater than 2 is a marker for hypo perfusion raises a concern for sepsis. Next up, we have letter B for Blood Cultures, make sure to have 2 samples, now that you have your blood cultures, you can move on to the next letter as in the letter C & it is the antibiotics that you're going to choose for this patient. Let's choose an antibiotic that starts with the letter C that's broad spectrum such as Ceftriaxone or maybe Cefepime or some other Cephalosporin. But it doesn't have to start with the letter C and often the empiric antibiotic is Vamcomycin. The next letter is the letter D, for drink & what I mean drink fluids I mean IV fluids. And if a patient is hypotensive, or has a lactic acid greater than 4 then crystalloid IV fluids are preferred such as normal Saline or lactated Ringer set at 30 mls per kg for a bolus. If the patient is still hypotensive despite the fluid challenge, let's go to the letter E and here, E stands for Epinephrine but here, really the preferred pressor is norepinephrine & that's usually reserved if IV fluid resuscitation has failed & the mean arterial pressure is less than 65 milliliters of Mercury & lastly, the letter F stands for finalizing, so if that lactic acid was high, greater than 2 it may be a benefit to repeat that lactic acid level. So there you go, the sepsis bundle, a guideline if implemented on time within 1 hour has the potential to decrease overall mortality & sepsis.
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