🔥 NORCET 11 SURE SUCCESS MARATHON (Class-1) | Latest Guidance On Sepsis (SSC 2026) | MEDsee Nursing

Added: 2026-05-19

[00:00:00]uh right so for the people who couldn't able to clear your prelims or mains uh in 10.0 into exam. So I want you people to start once again. So whatever happened it's happened right? See there is nothing called success and there's nothing called failure. Life is our life is like ECG right? It has ups and downs right.

[00:00:26]It has ups and downs. So uh that's the process. That's how the god made the human beings. Okay. Nothing to regret.

[00:00:34]So give a fresh start you to your 11.2 to preparation and there is nothing called impossible everything is possible right but yes you need that dedication confidence and discipline right without discipline even if you are talented that doesn't work okay so before talent what is required is discipline okay so I want my students to be disciplined and yes if you are if you have decided to prepare for 11.2 into yes you are that's your commitment right that's that's commit that is the commitment and don't forget the day one never forget right so the day one you should never forget clear I mean what is the day one so that is the day where you're going to start and you're going to assume yourself as an as nursing officer right you have assumed yourself as an um as nursing officer right So yes I should get so and so rank I should be nursing officer right so I should uh take my appointment letter from the administrative officer in as so that is what that you have decided on day one right so that is what I'm telling you never forget your day one clear okay so so starting with the lecture okay so this is a very important lecture again I'm telling you start making notes along with me take your register and make notes hand on hand along with me clear okay so starting with the sepsis guidelines 2026 so first I'll tell you the comparison the old guidelines and what are all the changes that they have made in the new guidelines I'm going to teach you people so first starting with screening screening tools right in my uh surgery class when I was discussing sepsis I taught you there something called QO so far right what is Q sofa quickly Quickly tell me what is squeeze so far.

[00:02:38]Right? Quickly tell me what is Q so far?

[00:02:41]Quick sequential organ failure assessment score. Right? Do you remember I taught you I given you a nice example of Royal Royal Challenges Bengaluru.

[00:02:50]Okay. RCB, right?

[00:02:54]But this is something else. These are the parameters that you find in Q so far. Right? So R for respiratory rate, C for consciousness and B for blood pressure. Okay, these are the three parameters. Each parameter will be given one point. Okay, 2 to three highly suspecting I mean it is associated with poor prognosis. Okay. So anyhow I taught you this clearly when I'm explaining you about uh the sepsis and septic shock in my surgery videos. But now here what you need to know is this is the old guidelines the Q sofa. But now the latest guidelines is telling you it is strictly telling you not to use this Q sofa score. Instead right, you had to go for something called as news national early warning score or news to score or muse modified early warning system Muse. So these are the scoring systems that the latest guidelines is recommending and it is no now no more recommending Q sofa scoring system right because it's due to the low sensitivity clear okay uh now again coming to the antibiotic timing so right so previously uh right once the septic shock the patient is getting diagnosed with septic shock And after you recognizing the septic shock within 1 hour I mean within 60 minutes you we used to give the antibiotics we used to initiate the antibiotic therapy okay but now they have revised it yes again it's with 1 hour for septic shock yes if you if you have recognized septic shock yes you have to administer antibiotics within 1 hour clear That's that remains unchanged. But what they have updated here is suppose there's a patient who is in sepsis but there's hemodynamically stable I mean there is no shock in that case the window period is 3 hours it is not 1 hour it is 3 hours allowing you to quickly investigate and take decision so that is what okay so I mean in the possible sepsis or uh seps right or sepsis without shock It will be the window period will be 3 hours to initiate the antibiotic therapy. But yes, within 3 hours you have to start uh antibiotic therapy.

[00:05:39]Clear? Okay.

[00:05:41]Now coming to antibiotics and strategy.

[00:05:44]Very very important. Coming to antibiotics and strategy. So previously uh the old guidelines we used to uh you it used to tell us okay early initiation of uh broadspectctrum antibiotics. Okay so early broadspectctrum antibiotics clear?

[00:06:10]uh now in the latest 2026 guidelines yes it is more towards the targeted therapy targeted everything is targeted and okay uh so there's something called deescalation so once uh right so what we actually do right we take the blood samples and we send it to the lab and we don't wait for the reports to come and just we start with antibiotics And once you get the reports, I mean the culture and sensitivity reports. Then what you are supposed to do? You have to deescalate. I mean uh as per your culture and sensitivity report you will deescalate. I mean you will you will remove the antibiotics from the treatment regimen whichever you need to remove. Right? The deescalation of antibiotics. Again this is uh this is what your 2026 guidelines is emphasizing.

[00:07:07]deescalate right deescalation is mandatory again and now coming for the fluid management very very important what you need to know in fluid management see uh previously in the old guidelines we used to crystalloids yes shock yes obviously there's something called crystalalloids and uh in the previous guidelines we We used to also give something called human albamin which is a colloid.

[00:07:41]Okay. Both are recommended and we used to do that as per the previous guidelines but now the latest guidelines is telling right rather crystalloids it is more focusing on balanced crystalloids right balanced crystalalloids like what is a balanced crystalalloid?

[00:08:05]Ringer lactate. Okay. And strictly it is telling no to colloids. No.

[00:08:13]Not to use colloids routinely.

[00:08:19]Okay. Yes.

[00:08:23]And next coming to blood cultures. Very very important. Previously two sets we used to take two sets of uh blood I mean two sets of samples for the blood cultures but now in areas like limited resources are available one set is also fine one set is also fine and coming to the serum lactate levels very very important uh marker uh right see what is serum lactate right Previously serum lactate it is not routinely recommended and it is not routinely done in all the cases but now in the latest guidelines serum lactate need to be done in all the cases right it is routinely recommended clear okay now they have made the serum lactate as it's a target marker also right so decreasing levels of lactate meaning a good prognosis clear serum lactate very very important So earlier it was I mean old guidelines it is not routinely recommended previously but now the latest it should be done routinely. I mean in all the cases yes you have to do serum lactate. Okay.

[00:09:48]To be routinely done. Yeah. Carried out.

[00:09:56]Okay. And coming to vasopressars very very important. So quickly tell me vasopressars.

[00:10:04]See vasopressars usually right if the patient is in I mean um sept septic shock we used to start with our fluids and then we used to go for vasopressars. Okay. But now I'll come to that the latest guidelines let me put it down here. So fluid and then the vasopressars but the latest guidelines is telling you suppose now there's a crashing patient who like I mean the septic shock patient who is crashing almost like hypotension you could able to see modeling uh modeling in the sense uh have you seen I I hope everyone would have completed your neonatal postings in your clinical area during your graduation. I hope you would have seen something called cutest marmmoreta in newborn babies. I taught you about cur cutis marmmoreta right uh during my neonatlogy classes. Yes. So that's how it appears. Okay. That's which is in adults right? Uh I'm talking about which is called as modeling.

[00:11:14]Clear? Okay. So if you see this so and right so you have to start fluid plus hand on hand you also should start with vasopressars clear so fluid plus vasopressars should go hand on hand and remember always the first line vasopressar that you need to start in a case of septic shock is Nor adrenaline. Okay, your norepinephrine. Okay, so remember it is norepinephrine your norad.

[00:11:58]Okay, remember this. Okay, the first line vasopressar that the guidelines is recommending it's norepinephrine. Okay, everything I'll discuss in the further slides. This is a comparison between the old guidelines and what are the changes that they have made in the latest new 2026 SSC campaign. Okay. So that is what now coming to respiratory support. Very very important. What you need to know in respiratory support previously it is like just standard oxygen therapy plus ventilation.

[00:12:35]But now it is something recommending.

[00:12:37]Now the latest guidelines it is more into use of HFNC. High flow nasal canula is preferred than the conventional oxygen therapy. Okay. So that is what uh right I taught you about high flow nasal canula in the recent FON class. Do you remember I have shown everything there something called humidifier and the Nassel prongs. Okay. And right so everything I taught you there in HFNC high flow NASL canula very important.

[00:13:05]Please go watch that lecture if you have not seen HFNC clear. And then HF right it is more uh into the use of HFNC high flow Nassel canula in the respiratory support and something called prone positioning. Pruning right we used to give prone position right. Yeah. So that is what it is also recommending uh to go for this prone positioning.

[00:13:35]clear.

[00:13:39]Uh yeah. And then coming to patient journey very very important. See previously in the old guidelines uh it is it was just focusing on the acute phase. I mean when the patient is in ICU setup only that it is uh the acute phase only when the patient is in uh septic shock that phase alone was covered. But now in the latest guidelines they also everything it is included pre-intraost I mean early detection ICU care and post sepsis recovery including follow-ups is also included in the patient journey here. So patient journey please write it down.

[00:14:18]So earlier it was just focusing on acute phase right. So the hospital stay the main hospital stay and the main um morbidity period is covered but now uh it is covering everything the early detection okay and the ICU care during uh the morbidity period and post sepsis recovery plus follow-ups post recovery plus follow-ups Even follow-ups are included. Okay, that is what the changes that they have made and previously few people I mean few incentivists used to give this vitamin C because of its antioxidant properties and uh IVIG IV imunoglobulins and routine right now nowadays the latest guidelines is not recommending this okay it is strictly telling the latest guidelines SSC 2026 is strictly telling now not to use vitamin C IB PIG routine antifungals everything is no strictly no clear okay please remember this point it's a very important point clear and now so as I've already told you so screening tools previously we used to go for Q sofa the RCB right but now uh the latest guidelines is telling you to use the scoring systems which like your new scoring system yeah muse scoring system now everything I'll just tell you in Inset exam they can ask you the parameters which are present in this uh scoring systems. No need to remember all this uh stuff I mean all this values are not required to remember for your exam but yes you have to remember the parameters at least. Okay. So it is going to have six to seven parameters.

[00:16:13]Okay. So what are all the parameters?

[00:16:14]You will have all the TPR BP the temperature respiration pulse BP everything is included and along with that you'll also have something called consciousness.

[00:16:24]Okay. Uh it is not the GCS here.

[00:16:28]Something we follow is ABPU. I'll tell you what is ABPU. Okay. That's how we assess very quick assessment of consciousness. Okay. I'll tell you what is ABPU. And u yeah consciousness and temperature is also included. I mean consciousness and SPO2. The oxygen saturation levels is also included. It's also uh something called the patient is on room air or the under oxygen support also. So this they have included here.

[00:16:55]Okay. All this or the parameters that you are uh going to see in a new scoring system. Clear?

[00:17:02]And anything zero can you see the white everything white the zero score uh whichever is getting 0 0 0 everything is normal right that's a normal finding and uh right so these values I mean here toward this side everything the higher values these are all these are the lower values for example if you can see the temperature hypothermia is also included hyperothermia is also included Similarly, brady taki bradipnia takipia brady cardia teakardia both the poles are included here in this news scoring system. No need to remember all these values. Just remember the parameters and the name of the scoring system. That's more than enough for your for your NOSET exam. And how do we interpret and how do you take care similar to how we give uh Q sofa scoring how do we give one two I mean every parameter is given one point and two to three right so that we the assessment is different right. So similar to that here if you can see right can you see this uh right anything 0 to four can be managed in the ward but anything five 6 and 7 anything that touches the score touches five it requires ICO care clear okay so this is what you need to know in the about the news scoring system national early warning score clear uh now coming to muse scoring system modified early warning system. So again no need to remember all these values okay just focus on the parameters alone all the parameters are same like your TPRP is present here and apart from the your TPRBP that is temperature blood pressure pulse and respiration you also have something called consciousness that is there and the only one parameter that you can able to see very newly in this muse scoring system is urine output very very important important. So that's the difference between Muse and Muse. Okay.

[00:19:12]Muse we don't have urine output but in muse yes we have something called urine output is given preference. Clear? Okay.

[00:19:21]And I already told you that in conscious level is assessed by AVPU. There's something called AVPU.

[00:19:29]I don't know whether I taught you this when I'm discussing uh the neuro part but yes try to remember this a quick assessment of the conscious level in the patient. Uh so the suppose the patient is alert like you and me. Yes. I write it as a in my uh treatment chart. Uh right I write it as a meaning alert.

[00:19:51]Okay. Now you you listening to my class and I am teaching you people. Yes you I what should I give you? Yes. It is a that means you're alert. Uh okay. So when I want to write V means verbal response. When the patient only responds to your voice then you make it as we the if you are giving some stimulus and the pain I mean uh the patient is responding to painful stimuli you give P. If the patient is not responding whatever you do the patient is not responding okay completely m you give u u means unresponsive clear okay this is a v pu scale okay this is a quick assessment of conscious level so that is what we do here in case of muse or muse clear okay now so there's something called golden har bundle very very important You people should know about this golden hover bundle. What you need to know, right? So this is the this is the same topic. Okay. So very very important. The first 1 hour after recognizing the septic shock, right? The first 1 hour the first 60 minutes is considered as golden hour. Okay. The first 1 hour is considered as golden hour. Very very important. And remember you have to what what all the steps that are included in this bundle.

[00:21:21]Bundle means a bunch of steps that you're going to follow. Clear? Number one, you have to measure the serum lactate levels. I've already told you the serum lactate levels. These are the perfusion marker. It's a very one it's a very nice perfusion marker. It is going to tell you right levels of lactate means low tissue perfusion. So right the patient is in septic shock. What do you mean by shock? low tissue perusion. So the tissue the cells at the tissue level right the microirculation whatever it is there it it right it is not get right the microirculation or at the tissue level it is there is low perusion right so due to which I when I say low perusion right uh when the very very less amount of blood is getting reached at your tissue level that means it is not getting proper oxygen When there is no proper oxygen, what is going to start there? Anorobic metabolism is going to start, right?

[00:22:21]This product is nothing but this lactate is nothing but it is produced due to anorobic metabolism. Clear? Okay. So, you are going to measure the serum lactate levels. Serum lactate again I'm telling you apart from your capillary refilling time I mean uh CRT. Yes, CFT capillary filling time that we check.

[00:22:42]Okay. So uh the serum lactate levels is also a nice perfusion marker. Clear?

[00:22:48]Okay. So high levels of lactate meaning low perfusion. Clear? So you have you have to measure the serum lactate levels and if it is greater than two you'll reassess. I mean recheck it once again.

[00:22:59]Okay. And uh this serum I already told you serum lactate it is not just uh blood test that you're doing it's alo target marker meaning so if you right the serum lactals high once you start the management it should drop meaning once it is decreasing the serum lactate levels are decreasing meaning it is associated with good prognosis clear and then you have to collect the samples within 1 hour everything all this which I'm going to discuss to be done within 1 hour of diagnosing or recognizing the septic shock in the patient. Okay.

[00:23:36]Number one, what you're going to do serum lactate levels and CFT right and what else you're going to do side by side is samples. You have to take the blood samples I mean for blood cultures.

[00:23:50]Okay. And then you don't wait for blood culture report here. Okay. It is going to take time until then the patient is in septic shock already. And if you don't initiate the empirical antibiotic therapy, the patient is going to collapse. So we I don't want my patient to go into collapse. So what I I've already taught you that you have to initiate antibiotic therapy within 60 minutes. That means in this golden hour itself you have to initiate the empirical uh antibiotic therapy and then once you get the culture and sensitivity report you will deescalate it. Clear?

[00:24:24]and a sample you have to take for the blood cultures and then you have before initiating the antibiotics always remember yes you have to start antibiotics within 1 hour in septic shock but before in giving uh I mean before administering administering antibiotics you have to collect the samples for blood cultures clear so that you don't get any false reports okay and then broadspectctrum antibiotics okay so yes you I have to initiate broadspectctrum antibiotics as soon as possible. I mean within 60 minutes. Okay. And then uh yes fluid resuscitation. So fluid resuscitation remember. So if the patient uh is hypotensive clear just a minute. If the patient is hypotensive or if the serum lactate levels is greater than or equal to 4 millles per liter. Yes, you have to start with fluid resuscitation and okay the I mean I taught you already they are more focusing on balanced crystalalloids okay it is not just crystalloids it is balanced crystalloids okay and then you have to start vasopress very very important when to start vasopress if the patient is still hypotensive if the patient is hypotensive during fluid resuscitation please Start vasopressars. I taught you the first line vasopressar that you're going to start is nor adrenaline. Don't forget that. Okay. So, and you start vasopressars and what what will be the target for that a map. Okay.

[00:26:06]Mean arterial pressure the target will be greater than or equal to 65. Okay, that should be the target when you are do the patient is on vasopressars.

[00:26:16]Clear? And now coming to antibiotics and strategy. Let us go in in detail into this antibiotics and strategy. I was just right sitting here and uh I was just uttering about all the antibiotics it should be started within 1 hour the antibiotic therapy and you have to deescalate that that comes here. Let me put it in a single slide and explain. So always remember once you have recognized the patient with septic shock within 1 hour yes you have to administer antibiotics and what they have revised I've already told you in the latest guidelines they have given a window period of 3 hours if the patient is in sepsis but there is no shock right in possible shock I mean there is sepsis uh but the patient is hemodynamically stable that means there is no shock in that case The window period is 3 hours allowing you to quickly investigate and go into the go through the case thoroughly. Right?

[00:27:13]Administering antibiotics within 3 hours. The window period of 3 hours is for sepsis without shock.

[00:27:25]Clear? And don't remember deescalation.

[00:27:29]Uh never forget this um deescalation is very much mandatory. Okay? So after you get the culture institute report you'll deescalate the antibiotics that is not required and then prolonged betalactum in very very important point that you should never forget. So this can be asked in your exams prolonged betalactum infusion preferred very very important.

[00:27:51]Suppose let us take pipein um pipelin plus tazobactum that is the brand name you get injection pipas okay so injection pipas uh so right if you like over 40 to 60 minutes if you are giving so here it is strictly recommending that I mean in this um the latest sepsis guidelines is recommending to prolong the administration time okay he had very very important again I'm telling If you prolonged beta lactum infusion. So if you were giving one 1 hour of infusion previously and completing it in the client but now you have to make it 3 hours. Okay. So that the mic I mean the minimum inhibitory concentration. So whatever the antibiotic you are giving it stays above your minimum inhibitory concentration. Okay. So what is minimum inhibitory concentration? It is the the right the the dose which is required right to inhibit the bacteria I mean the uh viable bacterial growth okay so that is the minimum inhibitory concentration you have to maintain uh the threshold okay above that so right minimum inhibitory concentration of the antibiotic so that meaning betalactam inhibitors or time dependent antibiotics clear very very important the beta lactum antibiotics or time dependent antibiotics very very important so again I'm telling you right pre if you were giving pipas over 1 hour infusion now the guidelines is telling give it for 3 hours the same injection same dose let let it keep for longer time so that it remains above the minimum inhibitory concentration and making it as a timed dependent antibiotic clear okay So now coming to the last slide. Yes, I'll conclude the class uh within a while.

[00:29:47]Right? Listen to this. So now coming to fluid resistation and vasopressars very very important. Balanced crystalalloids are now recommended. I've already told you RL ringer lactate is a balanced crystalalloid which is now recommended by the guidelines. Okay. Rather giving it just a crystalalloid go for ringer lactate which is a balanced crystal.

[00:30:08]Yes, the yes the crystaloid preferred is ringing lactate heart man solution but please remember in case of TBI that is traumatic brain injury cases the uh crystaloid still remains normal saline because uh this RL can exagerbate cerebral edema in case of TBI so I don't want to happen further exacerbate the condition in my client so I avoid ringing lactate in TBI I mean brain injury rather I go for something called normal saline. Clear? Okay. And avoid use of colloids. Very very important.

[00:30:46]Previously in old guidelines yes colloids like albamin was recommended but now it is strictly saying no to colloids. Okay. I mean the albamin.

[00:30:56]Clear. And avoid fluid overload.

[00:31:00]Very very important. While giving fluids to the client, I mean during fluid resuscitation, make sure that the patient doesn't go into fluid overload make sure use dynamic measures like you can use eco okay eco right uh checking IVC and everything you'll come to know uh that the patient is not going into fluid overload very important and then preferred firstline vasopressar coming to vasopressars remember I already told you the preferred Third first line basoprasar quickly tell me what is the guidelines the latest SSC 2026 guidelines is recommending the first line basoprasar start commenting please put that in the comment section my dears yes nutangwini excellent quickly given me the answer it is norepinephrine your nor adrenaline okay nor ADR is the one that you have to start.

[00:32:03]And yes, you can also add if needed, you can also add vasopressin injection vasopressin.

[00:32:18]Then if not you can go for the epinephrine that is the adrenaline injection adrenaline.

[00:32:24]Yeah, epinephrine. And uh okay in cardiac dysfunction cases which which vasopressar it is dobutamine doamine is recommended okay and uh strictly the guidelines is telling don't go for dopamine okay due to its uh adverse effects like uh cardiac ariththmias don't go for dopamine no role for dopamine here in the management so doputamine in case of cardiac dysfunction and fluids plus vasopressor's resistant septic shock.

[00:32:58]Now you have given the fluids enough amount of fluids. Remember the dose they'll also ask you the dose. Sometimes the balanced fluoids I told you right fluid resistation it is 30 ml per kg is the recommended dose. Okay. So even after giving all this fluids and vasopress starting the patient on adrenaline nor adrenaline okay that doesn't work that means it becomes fluid plus vasopress resistant septic shock.

[00:33:24]In this case you have to go for something called IV steroids like IV hydrocortisone.

[00:33:32]Clear? So we are done with the topic.

[00:33:36]Yes. These are all the changes that they have made in SSC 2026 surviving sepsis campaign 2026. And again I am alerting you people giving you people a red alert. Yes, you should never leave this topic and go for your AS exam because uh our AS examiners are more into the updates. Clear? Okay. Yeah. All the best. Okay. See you in next live class.

[00:34:03]Till then stay tuned.