Ebook "Sepsis Management: A Quick Guide"

31 July 2019



Finally, our ebook for sepsis management in our local setting was published!

Confuse about how to identify sepsis?

Confuse about how and when to use qSOFA score?

But eager to know the cheapest and simplest ways to monitor and manage sepsis in a busy and limited resources setting?

"Sepsis Management: A Quick Guide", this ebook is customised to suit our local setting and other low-middle income countries to provide you with the answer.

The book contains side by side illustrations with texts to unfold the complexity of sepsis and easy to understand. It also contains important pitfalls and tips while managing sepsis. Furthermore, the book is also equiped with google translation tool to accommodate readers of different languages.

This book is suitable for:

1. Doctors who work in district, Emergency Departments, ICU and Critical care unit. It also suitable for Infection disease specialists, pharmacists and healthcare providers,  especially those from low-middle income countries.

2. Paramedics and Nursing personals.

3. Scientists who is currently doing or wishing to do clinical research in sepsis.

Get a copy at Google Play Book Store with offer price at this link. (support for both ios and android user)

https://books.google.com.my/books/about?id=rvSiDwAAQBAJ&redir_esc=y











Sepsis Resuscitation and Monitoring Chart (SRMC) in Low-Middle Income Country Setting

27 Jun 2019
Due to the limited resources, our society had come out a simplified sepsis resuscitation chart for a appropriate goal directed and guided sepsis resuscitation management in emergency department and critical care unit. It is guided using pulse oximetry plethysmographic waveform analysis, Modified SOFA score and Frank Stratling Curve. This make sepsis management more easy and organised in our setting.


Link to download

PDF: https://drive.google.com/file/d/1bkZR5UBRRXL5jlKqcAFpZF7QoLPD0v5e/view?usp=sharing



PNG : https://drive.google.com/file/d/1ieHViRPwNI0iRzrdXMR_YH52fo3SuO5X/view?usp=sharing

2nd Malaysian Sepsis Evolution (MySE) Seminar

We are proudly present to you our 2nd Malaysian Sepsis Evolution (MySE pronouce as mice) Seminer. FINAL ANNOUNCEMENT.

The registration already open. Please come and join us. 

Click here for registration.








Sepsis Management Update- Advanced Level 

Organised by: Malaysia Sepsis Alliance
Speaker: Dr Tan Toh Leong
Senior Lecturer and Emergency Department
AMS UKMMC Committee
SIGMARIS MALAYSIA

Malaysia Sepsis Alliance in conjunction with Emergency Department of Universiti Kebangsaan Malaysia Medical Centre had organized a Sepsis Management Update Course on 18th January 2019. It involved specialist around Malaysia which included expert from emergency department, microbiology department, biochemistry department and etc. In this course, the understanding of sepsis was enlightened by all of expert from various field. Sepsis Identification and Management was greatly emphasized in this course where quick identification of Sepsis or Septic Shock in suspected patients, determination state of sepsis either SIRS, CARS or MARS, obtained suggested biomarkers and management of sepsis by initiate 1 hour bundle while maintaining the volume and cardiac contractility.









Intermediate Sepsis Workshop and Advance Hemodynamic Monitoring in ED (sponsor by Edward Lifescience) 

Speaker: Dr Tan Toh Leong
Senior Lecturer and Emergency Department
AMS UKMMC Committee
SIGMARIS MALAYSIA

On 14th December 2018, The Emergency Department of Universiti Kebangsaan Malaysia Medical Centre held an Intermediate Sepsis Workshop for all emergency physicians and post graduate doctors. It's a great pleasure to have this workshop sponsored by Edward Lifescience. The definition of sepsis and its clinical stages characterisation have been changing for the past decades until most recently in 2018. It remains high mortality rate and healthcare provider find it challenging to understand and manage sepsis. Thus, this workshop was held to augment the understanding and management on sepsis with an ultimate aim to identify and treat sepsis as early as possible based on the latest Survival Sepsis Campaign Guideline. In conjunction to the workshop, Edward Lifescience took this opportunity to introduce non-invasive ClearSight system which extends the benefits of continuous hemodynamic monitoring includes measuring stroke volume, stroke volume variation, cardiac output, systemic vascular resistance and continuous blood pressure.







Surviving Sepsis Campaign Guideline- 1 hour bundle 2018

Surviving Sepsis Campaign Guideline- 1 hour bundle 2018

The management of sepsis is challenging. Guideline had been form to facilitate this. MySepsis are supporting the recent updated Surviving Sepsis Campaign Guideline recommended by Society of Critical Medicine . We hope this will enhance the sepsis management in our local setting. #MySepsis

Please find the protocol at the following link


http://www.survivingsepsis.org/Guidelines/Pages/default.aspx

Marik Cocktail - a "cure" of sepsis?

Vitamin C, Thiamin and Steriod improve organ failure rec


The components of Marik’s life-saving sepsis cocktail are simply steroids and vitamins, a therapy, which many have said is harmless, but may improve sepsis survival dramatically. Steroids for sepsis have been around decades, and although there have been several trials evaluating its benefits in the septic patient; it is safe to say that the use of steroids remains controversial. The recently completed HYPRESS trial did not demonstrate a benefit for steroids in patients with sepsis.  How about the use of vitamin C and thiamine? This is not a new concept and there are studies demonstrating benefit so perhaps, combining all these “harmless” therapies would work on the deranged physiologic pathways that are present in the septic patient.

So the conjecture here is that Marik’s new cocktail has little patient harm because the individual components are individually benign and have been studied before. In fact, Marik himself has made the claim that withholding this therapy while waiting for a multicenter trial to be completed would be unethical. In support of his statement he has even invoked the infamous “parachute analogy” where some therapies are so obvious that it would be illogical to test them in a clinical trial.

Abstract 
Adapted from (Marik et al 2016)
Background: The global burden of sepsis is estimated as 15 to 19 million cases annually
with a mortality rate approaching 60% in low income countries.

Methods: In this retrospective before-after clinical study, we compared the outcome and
clinical course of consecutive septic patients treated with intravenous vitamin C,
hydrocortisone and thiamine during a 7-month period (treatment group) compared to a
control group treated in our ICU during the preceding 7 months. The primary outcome was
hospital survival. A propensity score was generated to adjust the primary outcome.

Findings: There were 47 patients in both treatment and control groups with no significant
differences in baseline characteristics between the two groups. The hospital mortality was
8.5% (4 of 47) in the treatment group compared to 40.4% (19 of 47) in the control group (p
< 0.001). The propensity adjusted odds of mortality in the patients treated with the vitamin
C protocol was 0.13 (95% CI 0.04-0.48, p=002). The SOFA score decreased in all patients in
the treatment group with none developing progressive organ failure. Vasopressors were
weaned off all patients in the treatment group, a mean of 18.3 ± 9.8 hours after starting
treatment with vitamin C protocol. The mean duration of vasopressor use was 54.9 ± 28.4
hours in the control group (p<0.001).

Conclusion: Our results suggest that the early use of intravenous vitamin C, together with
corticosteroids and thiamine may prove to be effective in preventing progressive organ
dysfunction including acute kidney injury and reducing the mortality of patients with
severe sepsis and septic shock. Additional studies are required to confirm these
preliminary findings.

The clinical trial paper can be found at this link

https://digitalcommons.odu.edu/cgi/viewcontent.cgi?article=1127&context=bioelectrics_pubs

For those who want to get a quick glance on this topic, please kindly go to this link (credits to R.E.B.E.L EM group making the topic easy to understand):

http://rebelem.com/the-marik-protocol-have-we-found-a-cure-for-severe-sepsis-and-septic-shock/




Sepsis Interprofessional Workshop Nottingham University 2018

Once a year, we will conduct a sepsis workshop for the pharmacy students from Nottingham University UK, China and Malaysia. The workshop aim to share our clinical experiances in managing sepsis with the future pharmacist-to-be. The workshop aim to expose the Pharmacist-to-be to recognize the important of sepsis and how to approach Sepsis in the interprofessional manner. Our team comprise of  an Emergency Physician Dr Tan Toh Leong, a senior asistant Medical Officer, Mr Muhammad Kamarul and a senior Nurse Mdm Premalatha who are all very enthusiastic in sepsis care. The workshop was successful delivered and the students love it so much.

The syllabus and contents are originated from SEPSIS TRUST, United Kingdom, which Sepsis Six was introduced.

The link : https://sepsistrust.org/professional-resources/education-resources/

THE SEPSIS MANUAL Edited by Dr Ron Daniels and Dr Tim Nutbeam, provides detailed education free of charge for every healthcare professional in the UK. It includes UKST’s ‘Sepsis Six’ pathway (which halves the risk of patients dying). You may download the pdf file at the link provided.

 https://sepsistrust.org/wp-content/uploads/2018/06/Sepsis_Manual_2017_web_download.pdf

With the alignment with aim of Global Sepsis Allince and Asia Pacific Sepsis Alliance, we are at  our best to increase sepsis awareness in our country (Malaysia).













SepsiDot (Trademark) Bacterial Rapid Diagnostic kit (10min) using sPLA2-IIa

SepsiDotTM    

Bacterial Rapid Diagnostic kit (10min) using sPLA2-IIa

Malaysia Sepsis Research Group had found a potential solution for rapid bacterial detection with 2 to 3 drops of blood within 10min. It can be done via a trienzymes biosensor with a portable digital reader. We found that secretary phospholipase A2 group IIa (sPLA2-IIa)  have a very high sensitivity and specitivity (AUC=0.97, Sn=94%, Sp=94%)  in distinguishing bacterial infection from viral (Tan et al 2016, Tan et al 2018).




We also pilot a second study involving 211 patient presented tovalidating the sPLA2-IIa against procalcitonin (PCT). The report was presented to the Annual Scientific Meeting in Emerging Infection And Treat 2017

Distinguish:      Sepsis     Bacterial
AUC
sPLA2-IIA          0.81.        0.93         
PCT                     0.79         0.89





In a lower middle income country, we don't have a much resource to investigate sofisticate sepsis. We in need a very rapid diagnostic method to distinguish bacterial sepsis and initiate antibiotic as to compliance to 1 hours antibiotic SSC guideline.

Video explaining how the test kit work:

Pay it forward: Sepsis no more.
A method to rapidly detect sepsis and a revolution the way how we approach sepsis.
















We had filed a patent on the invention. The publication (2018) on this POCT can be reach at below link


https://www.mdpi.com/1424-8220/18/3/686/html


The bedsite point-of-care will be expected to come out as soon after complete a proper clinical trail.

We are welcome any enquiry. Any enquiry, please email to sigmarismalaysia@gmail.com

Antimicrobial Stewardship Seminar 2018

UKM Antimicrobial Stewardship Seminar UKMMC 2018

We are proudly announce that we are going to launch our own Surgical Prophylaxis Protocol. This is the great work from our dedicated AMS team. We are sure it will be beneficial for our patient.

The protocol can be reach in the following link:

https://www.ppukm.ukm.my/farmasi/wp-content/uploads/2018/09/PPUKM-Surgical-Prophylaxis-26092018.pdf