tailieunhanh - Essential Guide to Acute Care - part 6

Mặc dù một lactate cao có thể là do các lý do khác (ví dụ như giảm giải phóng mặt bằng ở gan), bất kỳ bệnh nhân nhiễm trùng huyết và lactate tăng cao nên nhập các gói hồi sức nhiễm trùng huyết (Hình 6,5) ngay cả khi BP không phải là thấp. Nhiều khí máu động mạch phân tích lactate | 102 Chapter 6 prognostic indicator 10 . Although a high lactate can be due to other reasons . reduced clearance by the liver any patient with sepsis and an elevated lactate should enter the sepsis resuscitation bundle Fig. even if the BP is not low. Many arterial blood gas analysers measure serum lactate. Sometimes lactate may not be raised despite a metabolic acidosis with no other explanation apart from sepsis. In this situation enter the sepsis resuscitation bundle in the same way. Blood samples should be obtained as the patient is being cannulated for the administration of . fluid. At least two sets of blood cultures should be taken with at least 10 ml in each bottle as this increases the yield 11 . Do not wait for a pyrexia before taking blood culture samples. Pyrexia is only one indicator of severe sepsis and some patients may be hypothermic. Samples should also be sent for culture as soon as possible from any other potential source of infection intravascular devices urine wounds sputum and cerebrospinal fluid. Broad-spectrum . antibiotics should be administered not just prescribed within the first hour after recognition of severe sepsis. Antibiotic therapy will be tailored at 48-72 h depending on the results of cultures. The choice of broad spectrum antibiotic depends on the likely source of sepsis and local guidelines. Early antibiotic administration reduces mortality in patients with bacterial infections 12 . The main sources of infection in severe sepsis are the chest and abdomen including the urinary tract . A table of the commonly used first line antibiotics in the UK is shown in Fig. . Hypotension or an elevated lactate should be aggressively treated. The goals of resuscitation are to restore intravascular volume improve organ perfusion with vasopressors and or inotropes if necessary and maximise oxygen delivery. The principle of oxygen delivery was described in Chapter 2 in simple terms but will be expanded further below. In most .