EM:RAP 2018 May - Snack - Surviving Sepsis

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David P. -

The trend towards applying time metrics to our practice is becoming increasingly absurd. The push to standardize, streamline, and accelerate treatment times is eroding our ability to thoughtfully evaluate and treat each patient as an individual. The push for shorter and shorter door to cath lab, door to tpa, door to administration of sepsis bundles etc has crossed a line into unrealistic and at times dangerous territory for our practice and our patients. . We must resist. Sign that petition.

Ian L., Dr -

The need is for at least a doubling of the highly skilled staff for achieving the time metrics .
The evidence that treating eg meningitis as early as rather than late is one reason for chemoprophylaxis .

James C. -

Can this be moved out from behind the pay wall so we can link our non EmRAP listening colleagues to it?

Mel H. -

YEs - making this free to the world now

James C. -

Thanks! Posted it on the EmDocs facebook group. Hopefully the hive will take action.

Fen M., Dr -

Hi ,
My reading of the Surviving Sepsis Campaign Bundle, as published in Critical Care Medicine - says that the bundle is to begin in the first hour from triage but they recognize that "More than 1 hour may be required for resuscitation to be completed...". This is in the first paragraph.
We just need to initiate the bundle within the 1st hour ( though that in itself may be challenging!)

Hope this helps reduce the pressure!

Fen Moy

matt v. -

Mel-

If you could get in touch with Scott and clarify some things for all of us. As I read these new guidelines, the one hour bundle is based off of the SOFA (qSOFA) criteria. That the one hour bundle needs to be initiated after identifying sepsis based off of the qSOFA definition not SIRS. For a reminder, a person that triggers sepsis would need:

1. AMS
2. Hypotension
3. Tachypnea > 22

Based on these criteria, this is a person who needs close evaluation and more immediate attention. A 1 hour bundle could be applicable to a patient in this state. Yes, there will be some who clearly are not septic but meet these criteria, but far less than simply applying SIRS criteria.

The real issue we are going to see is with administration. Will they define sepsis as triggering SIRS criteria,

matt v. -

qSOFA or some amalgomation of the two??? The all knowing EMR is what is going to become the real bane of our existence

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EM:RAP 2018 May Snack Full episode audio for MD edition 6:39 min - 5 MB - M4A