Go ahead and post it. There will be a lot of people that will read it, and a lot of EMT's that will learn from the information you provide.
Sepsis Alert
- Thread starter LucidResq
- Start date
Go ahead and post it. There will be a lot of people that will read it, and a lot of EMT's that will learn from the information you provide.
As a Paramedic and parent f a child who has had a S Aureus sepsis twice in the last 7 weeks (well, unresolved rebound sepsis, 2nd time around) I can say EMS is important, but strong ER protocols are even moreso.
Present in the ER with a temp of 41.4*C (106.5*F), rigors and a HR of 185, have a Broviac in place and active use (TPN dependent), and the likelihood of sepsis is strong. Now, what if the WBC is WNL (10) and lactate is only high normal (2.2). Sepsis impossible? Well, according to the attending, yes - unfortunately, the discharge and subsequent readmission of a child who was "very critical" with a temp of 43.4*C (110*F) and a HR of over 240 6 hours later spoke volumes. The blood cultures drawn told us that she was, indeed, septic... and quite septic.
I'll be the first to admit I am jaded, but having been on both sides of this issue first hand, I fear that the Sepsis Alert, while a GOOD idea, whose time has come, only bears its value up to the point that care is handed over. Beyond that, it is missed sepsis cases (and she was not the only one this year - I was told of 3 others... one of which led to the death of a 20 month old boy) that lead to these obscene M&M rates.
Ryan, I look forward to hearing of your stud and its outcomes - and if I can help in any way, please do not hesitate to contact me.
Present in the ER with a temp of 41.4*C (106.5*F), rigors and a HR of 185, have a Broviac in place and active use (TPN dependent), and the likelihood of sepsis is strong. Now, what if the WBC is WNL (10) and lactate is only high normal (2.2). Sepsis impossible? Well, according to the attending, yes - unfortunately, the discharge and subsequent readmission of a child who was "very critical" with a temp of 43.4*C (110*F) and a HR of over 240 6 hours later spoke volumes. The blood cultures drawn told us that she was, indeed, septic... and quite septic.
I'll be the first to admit I am jaded, but having been on both sides of this issue first hand, I fear that the Sepsis Alert, while a GOOD idea, whose time has come, only bears its value up to the point that care is handed over. Beyond that, it is missed sepsis cases (and she was not the only one this year - I was told of 3 others... one of which led to the death of a 20 month old boy) that lead to these obscene M&M rates.
Ryan, I look forward to hearing of your stud and its outcomes - and if I can help in any way, please do not hesitate to contact me.
Sepsis and almost any infection is now a big issue for most hospitals and all should have their markers in place.
Some interesting QA/QI things:
IHI 100,000 Lives Campaign now 5 million lives:
http://www.ihi.org/IHI/Programs/Campaign/
Surviving Sepsis: has lots of information including guidelines
http://www.survivingsepsis.org/Pages/default.aspx
Pediatric Sepsis
http://www.pediatricsepsis.org/
A great article and information that is now being implimented worldwide:
The Checklist
http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande
Some interesting QA/QI things:
IHI 100,000 Lives Campaign now 5 million lives:
http://www.ihi.org/IHI/Programs/Campaign/
Surviving Sepsis: has lots of information including guidelines
http://www.survivingsepsis.org/Pages/default.aspx
Pediatric Sepsis
http://www.pediatricsepsis.org/
A great article and information that is now being implimented worldwide:
The Checklist
http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande
Sepsis is truly vastly underrecognized in the US prehospital environment. As Ventmedic said, there is a whole slew of paramedics and EMTs who fail to recognize how sick the folks their toting around really are.
As much as I would love to see point-of-care testing in EMS expand beyond BGL, how any people simply repeat the "treat the pt and not the monitor" mantra that's so prevelant in EMS? It's 2010 and we're still debating the usefulness of 12 leads elsewhere on this forum...
As much as I would love to see point-of-care testing in EMS expand beyond BGL, how any people simply repeat the "treat the pt and not the monitor" mantra that's so prevelant in EMS? It's 2010 and we're still debating the usefulness of 12 leads elsewhere on this forum...
I wouldn't say we're debating them. We have all proven they're useful. We're trying to convince the one out of a thousand that they are.
Yet, probably 50% of EMS providers that are ALS do not have 12-lead capability. We also still promote BLS only for many areas and some are reluctant to advance their service to ALS.
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My biggest issue with "treat the pt and not the monitor" is the automated BP. Take a real one. 2nd is the SpO2... lots of reasons it can fail.
A lactate monitor? Sounds neat.
I took a septic patient out of a SNF a couple of months back.. she stopped breathing halfway to the ED. That was interesting. I fully understand they are sick puppies.
Aidey
Community Leader Emeritus
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Amen! I've had fire medics start fluids "wide open" and plan on giving huge boluses after getting a low NIBP reading without ever confirming the BP.
I like the idea of a lactate monitor also. As was evidenced by the "Unresponsive in a nursing home" thread a couple weeks ago, other conditions can have the same signs as sepsis making it difficult to be sure what is going on.
I thought all ALS did 12 lead? Seriously, some don't do 12 leads pre-hospital? Wow.
I've seen regular medics to it too... At our service, we're required one set of manual vitals prior to vitals on a monitor.
If you take an ACLS class you will hear the stats I quoted.
Or, here is the quote from the AHA:
Dated Feb. 16, 2009
http://americanheart.mediaroom.com/index.php?s=43&item=677
Aidey
Community Leader Emeritus
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Sorry, I wasn't trying to pick on the fire medics where I am. The reason I specified them is because we don't have NIBP on our monitors but they do, so we have no choice but to do them manually.
Jeffrey_169
Forum Lieutenant
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We used to a while back. I never could understand why we stopped.
mycrofft
Still crazy but elsewhere
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Misdiagnosed infection
Elderly female with recurrent brociolitis, bronchitis, and recurrent GERD aspiration over the years. See by MD with fever, disorientation, weak cough, chest sounds with rales, ronchii, and just gargling going on below the manubrium. Sputum obtained for culture.
Two weeks later, pt much better, chest CTA (as clear as she gets), afebrile, CXR clear after course of oral antibiotics, and big dose of home cooking, oral fluids, rest and companionship.
Culture of sputum: Staph Aureus.
Bloodwork: normal CBC, al chems normal except very slightly elevated creatinine.
(Staph aureus brochiolitis / borderline pneumonia leaving a normal CXR two weeks later?? Normal CBC???).<_<
Elderly female with recurrent brociolitis, bronchitis, and recurrent GERD aspiration over the years. See by MD with fever, disorientation, weak cough, chest sounds with rales, ronchii, and just gargling going on below the manubrium. Sputum obtained for culture.
Two weeks later, pt much better, chest CTA (as clear as she gets), afebrile, CXR clear after course of oral antibiotics, and big dose of home cooking, oral fluids, rest and companionship.
Culture of sputum: Staph Aureus.
Bloodwork: normal CBC, al chems normal except very slightly elevated creatinine.
(Staph aureus brochiolitis / borderline pneumonia leaving a normal CXR two weeks later?? Normal CBC???).<_<
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