What would you do with that information??
What would you do with that information?
How would you know that the lactate is from sepsis and not from, say, mesenteric infarction or metformin?
[*]Suspected or documented infection
[*]Age > 18 years
[*]Not Pregnant
[*]Two or more of the following: Temp >100.3F or <96.8F, Pulse > 90, RR > 20
[*]Hypoperfusion as indicated by at least one: BP < 90, MAP < 65, or Lactate >= 4
Patients with cryptic septic shock may have relatively normal vital signs, except they will have an elevated lactate.
Why would you not already be resuscitating them?You use it coupled with the SIRS criteria to perform a Sepsis Alert / Code Sepsis protocol, which would help drive early goal directed therapy. The Denver Alert Protocol saw pretty significant decreases in mortality after its implementation:
True. But in these patients, would people actually measure lactates (they're well aren't they)? How are you determining that this is sepsis as opposed to anything else?Patients with cryptic septic shock may have relatively normal vital signs, except they will have an elevated lactate.
Why would you not already be resuscitating them?
How :censored::censored::censored::censored: are your EDs?No one said we wouldn't be. Some systems call Sepsis alerts much like a STEMI alert to get the ball rolling at the hospital prior to actually arriving there. Get pharmacy, an intensivist, an ICU nurse or two, lab along with others that I'm missing up and at 'em and into the ER waiting rather than playing the "paging" game and waiting for people.
How :censored::censored::censored::censored: are your EDs?
No one said we wouldn't be. Some systems call Sepsis alerts much like a STEMI alert to get the ball rolling at the hospital prior to actually arriving there. Get pharmacy, an intensivist, an ICU nurse or two, lab along with others that I'm missing up and at 'em and into the ER waiting rather than playing the "paging" game and waiting for people.
How :censored::censored::censored::censored: are your EDs?
You're kidding? To initiate treatment on a suspected sepsis patient? Most ERs should have STAT lab capability and alot of ER docs now how to start treatment since the guidelines are posted everywhere and there has been a major push in the hospitals for this over the past 10 years. That sounds like your ER doctors aren't at par with others if they don't know how to start treating a sepsis patient. Can't they start central lines or intubate without an intensivist? Why would an ICU nurse need to be there? The Sepsis Bundle is great and can easily be followed with others brought into but not a big production like what seems to be suggested.
When you have 4 hospitals serving a population of > 500k with one being a Level II trauma center and one of those hospitals is a band-aid station and another isn't much better things get a bit hectic at times.
Is that high or low?When you have 4 hospitals serving a population of > 500k
We don't call sepsis alerts in my system. I was just giving an example. I think it's pretty bold of you to say our ERPs are sub-par without knowing the system I work in or the hospitals that we work with. We have an excellent, more than capable group of Emergency Physicians in our area. Yes they can intubate and start central lines but you know they are going to be looking for a consult not long after that and with busy ICUs sometimes that can take a while.
But you would want them to not do their emergency physician bit and hand over care to intensivists because of a random number generator on your ambulance?We don't call sepsis alerts in my system. I was just giving an example. I think it's pretty bold of you to say our ERPs are sub-par without knowing the system I work in or the hospitals that we work with. We have an excellent, more than capable group of Emergency Physicians in our area. Yes they can intubate and start central lines but you know they are going to be looking for a consult not long after that and with busy ICUs sometimes that can take a while.
How :censored::censored::censored::censored: are your EDs?