Sepsis Alert

LucidResq

LucidResq

Forum Deputy Chief
Messages
2,031
Reaction score
3
Points
0
Last night a friend of mine went to a CE about sepsis and a program that some local hospitals will be implementing. Now this is all unclear to me because this was just stuff he told me, and he didn't even attend the entire CE. But, basically:

- About 60% of sepsis patients brought into the ER eventually die. This is a serious problem that has largely been slipping through the cracks.

- Because of this, local hospitals are implementing programs that foster aggressive treatment in both the prehospital and hospital settings.

- This includes a prehospital 'Sepsis Alert' program, comparable to stroke, trauma, etc alerts.

- Some ambulances may start carrying finger-stick lactate monitors (similar to glucometers) to help identify septic patients.

- Liberal IV fluids are encouraged. As my friend, who is an EMT-B with IV put it, he was told to start a large bore IV in each arm and give as much as 1-2 L of NS.

Anyways, I started looking around online and found this article which led me to the Surviving Sepsis Campaign.

Anyways, just wondering if anyone has heard or seen programs similar to this and what your opinions are.
 
Good. Perhaps as veneficous has stated, its time to consider thermometers on ambulances.
 
Never heard of it... but it sounds like it has potential.

Evidence-based medicine is good.
 
daedalus said:
Good. Perhaps as veneficous has stated, its time to consider thermometers on ambulances.
Click to expand...

? You don't carry a thermometer?
 
Virtually no scenarios posted here include temp,.

Didn't you hear every hospital in the USA us coated with C. difficele? Former Lt Governor of New York says so, must be true.

I've seen a handful of infectious disease cases go undiagnosed because no one knew what tetanus, toxic shock in a male, and early meningococcal meningitis look like. Public health in the next county south sees the occasional polio case among immigrants from Mexico. Don't get me started about TB!
 
I know a few people on this forum have read my posts about "sepsis protocols".

Unfortunately, many EMS providers have not paid any attention to sepsis because the patients are usually those "BS" nursing home calls at 0300 for a "temp" or UTI.
Some also complain that the nursing home RNs are just stupid to be calling an ambulance for something so "petty". Nurses are educated to recognize and suspect the signs of sepsis.

The patients might also be the young homeless drug or alcohol addicts that so many hate to do a thorough assessment on "because we know their problem" and just give a taxi ride to the hospital. Or, the dialysis patient that so many complain about. It could even be the executive that has ignored an infection of some type to where it has gotten out of control. Or, the recent surgical patient. Or, a spinal abcess developed in a young karate master who had non-radiographic changes a week prior after a fall.

Many ambulance providers don't see what happens to these patients after they drop them at the hospital. They don't stick around for the central line placement, the CVP and SvO2 measurements or the fluid resuscitation along with a possible intubation. One might also see O2 therapy done by a very protocol with a different theory behind it and SvO2, not necessarily SpO2.

Skin temps will also be deceiving. The skin may feel cool. Rectal or core temps will be more accurate. There are several factors that can qualify for a sepsis protocol and with an elevated lactate level, they may get the whole program.
 
I've had a couple of good sepsis patients, one I will never forget. He was in MODS and had a BG of 1700. Yes, 1700.

I like the idea of more aggressive sepsis protocols. The lactate detector sounds like it has potential, and I agree, a thermometer should be a requirement on every ambulance.
 
Vent, you are a shining exception.

..Thanks!.
 
Once again, this would be a greatly benefit patient care

If I could figure out how to find and post the thread that I posted about the postive benefits of themometers in pre hospital setting, I would...... Help! :blush:
 
Last edited by a moderator:
I brought in a sepsis pt with ALS support. The guy had been sitting in his car in a remote parking lot for over 12 hours when someone called it in. He was barely conscious by the time we go there and the only info we ever got out of him was his first name. His cell phone was on the seat next to him with about 30 missed calls. He was found lying on the ground next to his car and it was assumed by the caller to 911 that he was drunk and passed out.

He coded juat after we arrived at the ER and died a few hours later. His initial temp in the rig was 104. Ever since that day all medical pts get a temp. Its easy,quick and in my opinion part of doing baseline vitals. I'm not sure there's anything that would have made a difference with this particular pt since he was obviously down so long before being noticed.

And the skin temp being cool is right. His skin was almost cold because he had been lying on the ground in 38 - 40 degree temps for an unknown period of time.
 
When I got my medical asst, we were taught to take temps as part of the vitals. I was surprised to find out that emts are not required to get a temp. I think it should be mandatory it does not take a lot of time and it is one more thing you can inform the er about before hand to give them a better idea about what is really going on.
 
Bossy, did you ever find out what caused his sepsis?
 
LucidResq said:
Bossy, did you ever find out what caused his sepsis?
Click to expand...

No I didn't. He was a tourist here to meet some friends for a fishing trip so we didn't get the info we usually do during run review. He'd had no significant health history other than a mild stroke 8 years earlier. He had a personal physician and got regular check ups but other than that no meds other than a daily ASA and vitamins. I'm trying to remember his age.. I think it was late 60's early 70's.
 
BossyCow said:
He coded juat after we arrived at the ER and died a few hours later. His initial temp in the rig was 104. Ever since that day all medical pts get a temp. Its easy,quick and in my opinion part of doing baseline vitals. I'm not sure there's anything that would have made a difference with this particular pt since he was obviously down so long before being noticed.
Click to expand...

Temp is part of baseline vitals for my service. It isn't that hard to do.
 
EMS Sepsis Alert

I realize this is a little late, but I just found this thread. I am the primary investigator for the EMS Sepsis Alert project mentioned in the original post. This is going on, and it appears to be making a big difference in patient outcomes. I am not going to go too deep into things here since I am not sure anyone will even read this, but if anyone has any questions I will be happy to answer them. I can be contacted at ryanmayfield@centura.org

Ryan Mayfield
EMS Educator - QA/QI/Research
 
A good thread to revive. There was an article on NPR yesterday.

It was about hesitancy to sue the British NAtional Health Service, but the case in point was a man who mother was admitted for a fractured leg and died much later from nosocomial sepsis related to a decubitus.
It is about time rational prehospital protcols for detection and treatment septic or "toxic" shock be taught and initiated.
 
You must log in or register to reply here.
Back
Top