If I could retweet this, I would!! The discussion is largely academic unless we have a viral PCR which is 100% sensitive, 100% specific, and the results are available within the hour. In a patient who clearly has evidence of impending or actual organ dysfunction, I'd treat for both groups of pathogens until we know which is the culprit (and even then we may not be convinced the virus is acting alone!)
Ron On Mon, Jan 7, 2013 at 8:43 PM, Thomas Morris <[email protected]>wrote: > Dear Lisa > > Even though a virus, flu can also induce a cytokine storm, in fact this is > apparently the mechanism by which people who are dying of influenza die. > I'm sure 5 days of Antibiotics wouldn't cause much harm, indeed it would > be quite hard to tell in the most severe cases and we do know that flu > increases the chance of bacterial pneumonia > > Tom Morris > > Infectious Diseases SpR, Leicester > > > > On Sat, 5 Jan 2013 17:01:09 +0000 > "D'Amico, Lisa L" <[email protected]> wrote: > >> If the patient is identified as having the flu are you still using >> antibiotics with the patient? Or are you using both antibiotic and >> antiviral? >> >> Lisa >> >> >> Lisa D'Amico, DNP, MSN, RN >> Clinical Quality Consultant >> Provider Engagement Performance Partnerships2 >> Highmark, Inc. >> Fifth Avenue Place >> 120 Fifth Avenue, Suite 893 >> Pittsburgh PA 15222-3099 >> Office:412-544-6804 >> Fax:412-544-8135 >> [email protected] >> >> >> >> From: >> sepsisgroups-bounces@lists.**sepsisgroups.org<[email protected]>[mailto: >> sepsisgroups-bounces@**lists.sepsisgroups.org<[email protected]>] >> On Behalf Of Sara Valentine >> Sent: Thursday, January 03, 2013 3:53 PM >> To: 'Sue Beswick'; >> sepsisgroups@lists.**sepsisgroups.org<[email protected]> >> Subject: Re: [Sepsis Groups] changing the sepsis screen for flu season >> >> When assessing for severe sepsis, we adjust our treatment (appropriate >> volume of fluid and early antibiotics) depending on both assessment and >> symptoms. So, for instance, if the patient does test positive for flu, and >> has SIRS plus elevated lactate (>2.2-4) and/or new organ dysfunction, then >> they are treated for severe sepsis, regardless of infection. If the flu is >> the cause, just because it is viral doesn’t mean that it isn’t sepsis. Labs >> we run initially are the same as yours. Lactic acid is a good indicator of >> hypoperfusion, but doesn’t pertain just to sepsis, as lactic acid can be >> elevated for other physiologic reasons. But according to the SSC >> Guidelines, severe sepsis is defined as sepsis-induced tissue hypoperfusion >> or organ dysfunction OR Lactate 2.2-4 mg/dL. >> >> >> Sara Valentine, BSN, RN, CNRN >> Nurse Educator/Clinical Sepsis Coordinator >> Medical Center Hospital >> 500 West 4th Street >> Odessa, Texas 79761 >> ph: 432.640.1085 >> fax:432.640.2885 >> >> >> From: >> sepsisgroups-bounces@lists.**sepsisgroups.org<[email protected]> >> <mailto:sepsis**groups-bounces@lists.**sepsisgroups.org<[email protected]>> >> [mailto:sepsisgroups-bounces@**lists.sepsisgroups.org<[email protected]>] >> On Behalf Of Sue Beswick >> >> Sent: Wednesday, January 02, 2013 2:21 PM >> To: >> 'sepsisgroups@lists.**sepsisgroups.org<[email protected]> >> ' >> Subject: [Sepsis Groups] changing the sepsis screen for flu season >> >> Thank you all who responded. It was pretty clear that the majority do >> not adjust your screen during the flu season. >> >> But related to that – exactly what is your screen. Our is that when >> sepsis criteria is met – the RN gets a CBC with diff, serum lactate (we run >> on our ABG machine), metabolic pane, the first bld culture, a UA/urine >> culture and chest X-ray if resp symptoms. >> >> We are wondering if just the Lactate might be a good first step to rule >> out severe sepsis and then treat the flu. Or do you do all the same >> tests/labs that we do? >> >> Thanks >> Sue >> >> Sue Beswick RN, MS, CCNS, CCRN >> Clinical Nurse Specialist - MSICU >> Greenville Hosptial System >> University Medical Center >> Greenville, SC >> Office: 864-455-4884 >> >> AACN Theme "Dare To" What are you going to dare to do this year? >> >> ______________________________**__ >> CONFIDENTIALITY NOTICE: The documents accompanying this email >> transmission contain confidential information belonging to the sender that >> is legally privileged. This information is intended only for the use of the >> individual or entity named above. 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