OB Sepsis Escape

Escape Room

MEWT& OB SEPSIS

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BACK TO THE FUTURE

Our time machine has broken down. To repair it we need to acquire information about MEWT triggers and managing sepsis in the obstetric patient. Visit the different "sepsis eras" and pass the tests to collect all the parts. But be careful, if you falter during the search, the temporary doors might close, making it more and more difficult for you to return.

ControlSYSTEM

The fuel will be topped up by finding the missing parts.

Appropriate Management

MEWT: Triggers & response

Visit all stages, fix the control system and go back to the future!

septic shock

the Detection period

Foundations: MEWT Triggers

• Systolic BP(mmHg): <90 or >160​

• Diastolic BP(mmHg): >100

• Heart Rate:<50 or >120​

• Respiratory Rate:<10 or >24​

• O2 sat on room air%:<95​
• Temperature: <36 C or >38 C​

• Oliguria, mL/hr x 2hrs:<35​
• WBC: <4,000 or >15,000

1/3

WHAT ARE SOME LEADING CAUSES OF MATERNAL SEPSIS?

Septic abortion,Chorio, OR Intraamniotic Infection

Mastitis Wound Infection

All of these choices are correct

pyelonephritis appendicitis Cholecystitis

2/3

Which of the following would patients trigger mewt and warrant further investigation?

• PP Vag delivery x 16 hrs w/ foul discharge
• Temp: 101.4 F
• HR: 124
• rr: 17
• BP: 112/80
• SpO2: 98%

• 39.2 Weeks SROM in labor x 6hrs
• Temp: 98.9 F
• HR: 98
• RR: 18
• BP: 128/78
• SpO2: 99%

• 31.2 Weeks Mag for PTL& PPROM
• Temp: 97.9
• HR: 84
• RR: 17
• BP: 138/88
• SpO2: 100%

• 36.6 Weeks in OBED w/ irregular contractions
• Temp: 99.1 F
• HR: 72
• RR: 16
• BP: 134/86
• SpO2: 100%

3/3

When conducting your sepsis screening, 2 or more postive sirs (systemic inflammatory response) indicate sepsis. which of the following data sets meet a postive sirs?

T- 100.4 FHR- 98 R- 16 WBC- 11, 000

T- 98.1FHR- 85 R- 18 WBC- 4,000

T- 101.4 FHR- 105 R- 22 WBC- 18,000

T- 100.1HR- 100 R- 24 WBC- 12,000

brilliant!

The trip has been a success, here is the piece you need. The next stage will be activated.

Control SYSTEM

Appropriate management

Septic shock

The dETECTION PERIOD

dETECTION PERIOD

The detection period is the time from suspicion of sepsis to diagnosis. What do we assess during the detection period? Let's find out!

1/3

Which factors put a maternal patient at risk for an infection? An active infection is ONE componenet that is assessed during the detection period.

Pitocin augmentation,Terbutaline administration, Insulin therapy

Prolonged labor, Prolonged ROM, Fetal tachycardia, Rescue cerclage, History of UTIs

2/3

A change in clinical status is another component of the detection period for sepsis. (true/false)

TRUE- A change in clinical status can include S/S of respiratory or urinary infections (etc.), uterine tenderness, foul smelling vaginal discharge, or MEWS trigger specifically for abornmal temperature or tachycardia

FALSE- Maternal patients who are potentially septic never demonstrate clinical status changes.

3/3

what is the third component of the sepsis detection period?

Abnormal lab results (for example: elevated WBC count

Persistent hypotension and hypoperfusion

Sustained maternal bradycardia and hypertension

brilliant!

You know the steps of detecting sepsis in your patient! Let's look at how sepsis progresses next.

control system

Clinical progression

MANAGEMENT

How do I manage a patient with sepsis appropriately?

• Principle 1: Initiate the 1 hour sepsis bundle and then treat the source of infection.

• PRINCIPLE 2: Frequently assess your patient's volume status.

• Principle 3: Normalize the patient's lactate level.

sEPSIS GUIDING PRINCIPLES

1/3

The 1 hour sepsis bundle includes: IV fluid bolus, draw blood cultures x 2, Draw lactate, Give antibiotics

true

false

2/3

Which two antibiotics cover approximately 90% of organisms that cause obstetric sepsis?

Vancomycin and penicillin

ampicillin and gentamICin

3/3

What is the purpose of normalizing a lactate level?

Decreased risk of DIC

Improved tissue perfusion

brilliant!

You know how to appropriately manage your septic patient! The last topic we will cover is septic shock.

control system

Septic shock

Septic Shock

If left untreated, sepsis can lead to shock. Septic shock (in the non-laboring patient)is diagnosed when a patient experiences hypotension with the need of vasopressor support to maintain a MAP >65 AND has an elevated serum lactate >4 mmol/L.

"SPECIAL NOTE*:Labor can cause falsely elevated lactate levels; therefore, lactate levels should not be considered when a patient is in labor. Instead consider BP and other MEWS/SIRS triggers.

1/3

The outcome and survivability in severe sepsis and shock in pregnancy are improved with early detection, prompt recognition of the source of infection, and targeted therapy.

true

false

2/3

The clinical cascade leading to septic shock begins with volume depletion.

true

false

3/3

If a septic patient is not responsive to treatment or experiences septic shock, it is reasonable to consider transferring them to a higher level of care.

true

false

congratulations!

You've managed to travel back to the present and approrpiately care for your septic patient! You will need CODE: 1212 for HS completion!

wrong

Please review SIRS parameters for pregnant patients:

• Temp >100.4 or <96.7
• HR >110
• RR >24 OR PaCO2 <32
• WBC > 15,000 or <4,000

REMEMBER: 2 OR MORE POSITIVE SIRS = SEPSIS THESE ARE ALL EARLY SIGNS OF INFECTION

wrong

The time door has closed, be careful or you will not be able to return to the present.