1. the official training programme of the Surviving Sepsis Campaign

5. Lung 1 Colon 2 Breast 3 Sepsis 4 cancers Annual UK mortality (2003), thousands 1,2,3 www.statistics.gov.uk,, 4 Intensive Care National Audit Research Centre (2005) A U.K. Perspective

6. Identifying the Septic Patient

8. Step 1: What is SSI? A systemic response to a nonspecific insult Infection, trauma, surgery, massive transfusion, etc Defined as  2 of the following : Temperature >38.3 or <36 0 C Heart rate >90 min-1 Respiratory rate >20 min-1 White cells <4 or >12 Acutely altered mental state Hyperglycaemia (BM>6.6) in absence of DM Identifying sepsis SIRS SEVERE SEPSIS

9. Step 2: What counts as an infection? Pneumonia Urinary Tract infection Meningitis Endocarditis Device related Central line Cannula Abdominal Pain Diarrhoea Distension Urgent laparotomy Soft tissue/ musculoskeletal Cellulitis Septic arthritis Fasciitis Wound infection Identifying sepsis

14. Are any 2 of the following present and new to the patient? Temperature >38.3 or <36 0 C Heart rate >90 min -1 Respiratory rate >20 min -1 White cells <4 or >12 g/L Acutely altered mental status Hyperglycaemia (glucose>6.6mmol/L) (unless diabetic) Screening Tool Severe Sepsis Screening Tool If yes, patient has SSI

15. Is the history suggestive of a new infection? Pneumonia UTI Abdo pain/ diarrhoea/ distension/ urgent laparotomy Meningitis Cellulitis/ septic arthritis/ fasciitis/ wound infection Endocarditis Catheter (incl central venous) infection Screening Tool If yes, patient has SSI If yes, patient has SEPSIS

16. Are any of the following present and new to the patient? Blood pressure systolic <90 or mean <65 mmHg New or increased O2 requirement to maintain SpO2>90% Creatinine >177 mmol/l or UO <0.5 ml/kg/hr for 2 hrs Bilirubin >34 mmol/l Platelets <100 Lactate >2 mmol/l Coagulopathy: INR>1.5 or aPTT>60s Screening Tool If yes, patient has SEPSIS The patient has SEVERE SEPSIS Start Severe Sepsis Care Pathway

25. the official training programme of the Surviving Sepsis Campaign Questions