end tidal CO2 for sepsis alert

[NomadicMedic]

Theres a piece in the Orlando Sentinel about etco2 as a trigger for sepsis alerts.

http://www.orlandosentinel.com/health/os-sepsis-screening-orange-county-20160504-story.html

Thoughts? I thought POC lactate was the prehospital sepsis standard.

 

[Underoath87]

I only know of 1 dept in Central FL that does lactate screenings (because they're really expensive).

But in the adjacent county, we've been using EtCO2 as part of our sepsis screening for a few years.

Our sepsis alert form/protocol reads:

1) Is there an already documented or suspected infection such as: Pneumonia, UTI, MRSA, Nursing home patients, indwelling catheters, immune compromised, etc.

2) The patient has 2 of the following SIRS variables:
Temperature of > 38 C (100.4 F) or < 36 C (96.8F)
HR of > 90/min
Respiratory rate > 20/min


3) The patient has an ETCO2 < 25 mm Hg
OR Lactic Acid > 4 mmol/L
OR Modified Shock Index of < 0.7 or > 1.3 (Modified Shock Index = Heart Rate / MAP)

If any of the 3 sections is a "no", the pt is not a sepsis alert.

 

[Summit]

How many EMS agencies have POC lactate? I'd wager not many.
There was criteria for pCO2 as one of the SIRS criteria, so they are basically attempting to approximate low pCO2 via ET.

Now, I'm a big ole fan of ETCO2. It's great and underutilized prehospital and inpatient.

That said, this is a rather sad example of EMS blindly groping to catch up to the evidence. And... yea... the evidence to support SIRS criteria sucked very badly (it was about as specific as a politician) as did a great number of the attached interventions.

That's OK. CMS has the same problem as EMS just now making the sepsis bundle part of the Core Measures... what a load of steaming crap. Just as we are learning it was not achieving, the government finally comes around to saying "now you have to do it or no money for you!"

Meanwhile, you'll find the newest consensus on Sepsis (Sepsis-3) which came out 3 months ago and we'd been hearing rumblings about for quite some time both eliminates SIRS and does not use pCO2 nor ETCO2 and instead uses SOFA or the modified quick version. I'll try to find some articles to link, but EMS can be looking at mental status, SBP, and RR.

So what do I think? I think, good work... welcome to 8 years ago!

 

[Tigger]

Theres a piece in the Orlando Sentinel about etco2 as a trigger for sepsis alerts.

http://www.orlandosentinel.com/health/os-sepsis-screening-orange-county-20160504-story.html

Thoughts? I thought POC lactate was the prehospital sepsis standard.

Unfortunately there is no FDA approved POC lactate meter. There's I-Stats and EPOCH but those are expensive and cumbersome. We just got an I-Stat for community health partnership and it is not the easiest device to use.

This JEMS article is decent and links to several studies, thought they are not equivocal.

 

[NomadicMedic]

Unfortunately there is no FDA approved POC lactate meter. There's I-Stats and EPOCH but those are expensive and cumbersome. We just got an I-Stat for community health partnership and it is not the easiest device to use.

This JEMS article is decent and links to several studies, thought they are not equivocal.

LactatePRO is. Of course it's discontinued, but strips are still available. And if you've got one, you can still use it. We've got them here, but I think I'm the only one who's used it in the last year.

 

[Chewy20]

Seems like Orange County is behind the 8 ball a little bit with this whole ETCo2 in sepsis thing.

We were going to have an official "Sepsis Alert", until they discontinued the LactatePRO before we received them. Now we just in-code with our findings and the hospital is usually smart enough to get the sepsis train going.