Again I think we are making this more complicated than it needs to be. If you are SIRS positive and have a confirmed or suspected source YOU ARE SEPTIC by definition. Treat them or the mortality rate will continue to rise. The evidence is there.
Jeffrey R Hanlon RN Stamp Out Sepsis ---- Original Message ---- From: Rich Levrault <[email protected]> To: Ron Daniels <[email protected]> Cc: sepsisgroups <[email protected]>; Sue Beswick <[email protected]> Sent: Sat, Jan 19, 2013 1:17 pm Subject: Re: [Sepsis Groups] changing the sepsis screen for flu season Do facilities screen all pts w sirs and source at triage?? Our Ed is worried about over screening and the potential for sending labs on everyone. There are pts who present w fever and tachycardia who routinely don't have labs sent. What are other facilities doing? Sean or Mitchell can you provide some backup for a former fellow who's pushing to cast a broad net and is advising to screen everyone? Ron...another sepsis guru .. Advice? I feel like I'm losing ground at our institution. Rich Levrault Sent from Rich's iPhone On Jan 8, 2013, at 9:46 AM, Ron Daniels <[email protected]> wrote: 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: [email protected] [mailto:[email protected]] On Behalf Of Sara Valentine Sent: Thursday, January 03, 2013 3:53 PM To: 'Sue Beswick'; [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: [email protected]<mailto:[email protected]> [mailto:[email protected]] On Behalf Of Sue Beswick Sent: Wednesday, January 02, 2013 2:21 PM To: '[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. The authorized recipient of this information is prohibited from disclosing this information to any other party and is required to destroy the information after its stated need has been fulfilled. 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The views expressed in this e-mail message do not necessarily represent the views of Highmark Inc., its subsidiaries, or affiliates. _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org -- Dr Ron Daniels CEO: Global Sepsis Alliance Chair: United Kingdom Sepsis Group Principal Trustee: U.K Sepsis Trust Founding Director: Survive Sepsis Fellow: NHS Improvement Faculty Suspect Sepsis: save someone's life today. Join us for World Sepsis Day on September 13th Twitter: @sepsisuk _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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