🏥 SPA (Septic Shock Perfusion Analyzer) version 2.1

Clinical Decision Support Tool for ICU Residents; Software License: GNU GPL v3. Copyright (C) [2026] [Prof. Jyotirmay Kirtania].

Patient Assessment

⏱️ CRT Measurement Timer

Press START, apply pressure for 5 seconds, release when timer shows "RELEASE", then press STOP when color returns
0.0s
Ready

📚 Quick Reference Guide

Normal Values

ParameterNormalAbnormal
CRT< 3 seconds≥ 3 seconds
Mottling Score0-2≥ 3
Tskin-diff0.0-0.2°C> 4.6°C
Tc-toe5-7°C≥ 10°C
PPI> 1.4< 0.7-1.4
💡 Temperature Measurements: Use infrared non-contact thermometer. Ambient temperature should be controlled (20-24°C). The app automatically calculates gradients for you!

CRT Measurement Protocol

  1. Apply firm pressure with glass slide to fingertip/earlobe for 5 seconds
  2. Count aloud: "1001, 1002, 1003, 1004, 1005" during compression
  3. Release at "1005" and continue counting
  4. Stop when color returns: "1006, 1007, 1008..."
  5. CRT = total count minus 1005

Resuscitation Timing

  • Initial: Measure CRT every 10-15 minutes during active resuscitation
  • Post-bolus: Reassess at 10-12 minutes (peak response time)
  • Stable: Hourly CRT monitoring
  • Temperature gradients: Every 2-4 hours

Fluid Bolus Protocol

  • 500 mL balanced crystalloid (RL/Plasma-Lyte) over 15-30 minutes
  • Reassess CRT at 10-12 minutes
  • If improved but still ≥3 sec: Consider additional bolus
  • If no improvement: Consider cardiac dysfunction or excessive vasoconstriction

Hemodynamic Dissociation Red Flags

Danger: MAP ≥65 mmHg + adequate CO BUT persistent poor peripheral perfusion

Actions:

  • Reassess fluid status (echo, dynamic parameters)
  • Consider reducing vasopressor if excessive
  • Trial inotrope (dobutamine 2.5-5 mcg/kg/min)
  • Consider low-dose vasodilator (NTG 10-20 mcg/min)

🔄 Clinical Decision Algorithm

Step 1: Initial Assessment

Measure CRT, Mottling, Temperature Gradients, PPI alongside lactate, MAP, UOP

Step 2: Is CRT ≥ 3 seconds?

YES → Proceed to Step 3

NO → Continue standard care, reassess hourly

Step 3: Fluid Resuscitation

Give 500 mL balanced crystalloid over 15-30 minutes

Step 4: Wait & Reassess

Wait 10-12 minutes, then reassess CRT

Step 5: Did CRT improve?

YES but still ≥3 → Consider additional bolus

NO improvement → Check MAP/CO adequate?

Step 6: MAP/CO Adequate but Poor Perfusion?

Consider:

  • Reduce vasopressor if excessive (check dose)
  • Add inotrope (dobutamine)
  • Trial low-dose vasodilator (NTG)
  • POCUS for cardiac function
  • Address anemia, hypoxemia, metabolic issues
💡 Pro Tip: Always document trends, not just single values. Serial measurements are more valuable than isolated readings.

Software License: GNU GPL v3. Copyright (C) [2026] [Prof. Jyotirmay Kirtania]. This program is free software: you can redistribute it and/or modify it under the terms of the GNU General Public License as published by the Free Software Foundation, either version 3 of the License, or (at your option) any later version. This program is distributed in the hope that it will be useful, but WITHOUT ANY WARRANTY; without even the implied warranty of MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the GNU General Public License for more details. Medical Disclaimer (Cognitive Assist & Record Keeping). IMPORTANT: PLEASE READ CAREFULLY BEFORE USE. NOT A MEDICAL DEVICE: This tool is a Clinical Decision Support System (CDSS) intended for educational and cognitive assistance purposes only. It has not been cleared or approved by the FDA, EMA, or any other regulatory body for use as a primary medical device. NO SUBSTITUTE FOR CLINICAL JUDGMENT: This tool is designed to assist, not replace, the clinical judgment of qualified healthcare professionals. All calculations and logic must be independently verified against institutional standards before clinical application. DATA PRIVACY: This tool is designed to run locally on the user's device. No data is transmitted to external servers by the software. The user is solely responsible for ensuring that the use of this tool complies with local patient data privacy laws (e.g., HIPAA, GDPR) and institutional IT policies. LIMITATION OF LIABILITY: In no event shall the authors or copyright holders be liable for any claim, damages, or other liability, whether in an action of contract, tort, or otherwise, arising from, out of, or in connection with the software or the use or other dealings in the software.

References:

1. Guo, Q., Liu, D., Wang, X. et al. Early peripheral perfusion monitoring in septic shock. Eur J Med Res 29, 477 (2024). doi: 10.1186/s40001-024-02074-1

2. Hernández G, et al. Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA. 2019 Feb 19;321(7):654-664. doi: 10.1001/jama.2019.0071.

3. Ait-Oufella H, et al. Capillary refill time exploration during septic shock. Intensive Care Med. 2014 Jul;40(7):958-64. doi: 10.1007/s00134-014-3326-4.

4. Lima A, Bakker J. Clinical assessment of peripheral circulation. Curr Opin Crit Care. 2015 Jun;21(3):226-31. doi: 10.1097/MCC.0000000000000194.

📋 Assessment History

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