Answer: When you are producing clinically problematic worsening of oxygenation status (or rarely clinically significant worsening of unvented IACS).
With that much crystalloid you should also be considering adding albumin. From: [email protected] [mailto:[email protected]] On Behalf Of Ahmed Mohamed Mukhtar Sent: Friday, January 25, 2013 10:22 AM To: [email protected] Subject: [Sepsis Groups] maximal volume in severe sepsis and septic shock Hi All I read the new guideline of surviving sepsis campaign and it stated that ' Initial fluid challenge in patients with sepsis-induced tissue hypoperfusion with suspicion of hypovolemia to achieve a MINIMUM of 30 mL/kg of crystalloids' My question is what is the maximum fluid therapy during early resuscitation. In our hospital we put 60 mL/kg as the maximum volume of fluid resuscitation. Is there any published guidelines about the maximum volume resuscitation in septic shock Regards Ahmed Mukhtar On Fri, Jan 25, 2013 at 4:58 PM, <[email protected]<mailto:[email protected]>> wrote: Send Sepsisgroups mailing list submissions to [email protected]<mailto:[email protected]> To subscribe or unsubscribe via the World Wide Web, visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org or, via email, send a message with subject or body 'help' to [email protected]<mailto:[email protected]> You can reach the person managing the list at [email protected]<mailto:[email protected]> When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." Today's Topics: 1. Repeat Blood Cultures (Stotts, James) 2. Sepsis Screening in Oncology and Transplant Patients (Stotts, James) 3. survivor resources (Maurene Harvey) 4. New Sepsis Guideline (seyed mohammad reza hashemian) ---------------------------------------------------------------------- Message: 1 Date: Thu, 24 Jan 2013 22:05:55 +0000 From: "Stotts, James" <[email protected]<mailto:[email protected]>> To: "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>> Subject: [Sepsis Groups] Repeat Blood Cultures Message-ID: <[email protected]<mailto:[email protected]>> Content-Type: text/plain; charset="us-ascii" Hi All, At University of California San Francisco Medical Center we are developing a standardized protocol for drawing blood cultures. Do any of you have standards as to when blood culture can/should be drawn, especially repeat cultures. Our clinicians advise not to draw repeat cultures in less than 24-48 hours. Jim Stotts RN, MS, CNS Sepsis Project Manager | Innovations In Population Health (DSRIP) University of California San Francisco Medical Center [email protected]<mailto:[email protected]><mailto:[email protected]<mailto:[email protected]>> (c) 415-717-0098 (o) 415-514-8495 -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20130124/89bb3d0d/attachment-0001.htm> ------------------------------ Message: 2 Date: Thu, 24 Jan 2013 22:34:02 +0000 From: "Stotts, James" <[email protected]<mailto:[email protected]>> To: "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>> Subject: [Sepsis Groups] Sepsis Screening in Oncology and Transplant Patients Message-ID: <[email protected]<mailto:[email protected]>> Content-Type: text/plain; charset="us-ascii" Hi All, Does anyone have sepsis screening criteria that is tailored to Oncology or Transplant Patients that they would be willing to share? We are looking to spreading sepsis screening from pilot units to the rest of the organization with a high volume of Oncology and Transplant patients, and are thinking that the usual SIRS criteria may miss or over identify patients as a positive screen. Jim Stotts RN, MS, CNS Sepsis Project Manager | Innovations In Population Health (DSRIP) University of California San Francisco Medical Center [email protected]<mailto:[email protected]><mailto:[email protected]<mailto:[email protected]>> (c) 415-717-0098 (o) 415-514-8495 -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20130124/5164d360/attachment-0001.htm> ------------------------------ Message: 3 Date: Wed, 23 Jan 2013 09:23:55 -0800 From: "Maurene Harvey" <[email protected]<mailto:[email protected]>> To: <[email protected]<mailto:[email protected]>> Subject: [Sepsis Groups] survivor resources Message-ID: <[email protected]<http://gmail.com>> Content-Type: text/plain; charset="us-ascii" Are any of you providing sepsis survivors and their families with resources to help them deal with potential long term consequences? The post acute care community is largely unaware of what problems our patients and their families might suffer. Giving information to the patient and family might help them understand what they are experiencing and lead them to seek out appropriate care referrals. Available resources include: 1. Sepsis Alliance- sepsisalliance.org<http://sepsisalliance.org> - support for sepsis survivors 2. ARDS Foundation- ardsusa.org<http://ardsusa.org> - support for ARD survivors 3. SCCM MyICUCare - sccm.org<http://sccm.org> - information brochures for patients and families including one on sepsis 4. UK NICE Self-directed ICU recovery manual - nice.uk.org<http://nice.uk.org> - recommendations for physical and cognitive recovery SCCM has a task force working with stakeholders across the continuum of care to address the issues and create more resources. Thanks for all you do, Maurene Harvey RN MPH MCCM -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20130123/b78534b6/attachment-0001.htm> ------------------------------ Message: 4 Date: Wed, 23 Jan 2013 04:40:26 -0800 (PST) From: seyed mohammad reza hashemian <[email protected]<mailto:[email protected]>> To: Jeffrey R Hanlon RN <[email protected]<mailto:[email protected]>>, "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>>, "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>> Cc: "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>>, "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>> Subject: [Sepsis Groups] New Sepsis Guideline Message-ID: <[email protected]<mailto:[email protected]>> Content-Type: text/plain; charset="utf-8" Dear friends; It was a?great ?day for Sepsis campaign group for presentation of new sepsis guideline here in SCCM congress ,if you like to read the new guideline and more details please see the? link: ? Seyed Mohammadreza Hashemian.MD.FCCM Associate professor of NRITLD/SBMU http://www.survivingsepsis.org/Guidelines/Pages/default.aspx? ________________________________ From: Jeffrey R Hanlon RN <[email protected]<mailto:[email protected]>> To: [email protected]<mailto:[email protected]>; [email protected]<mailto:[email protected]> Cc: [email protected]<mailto:[email protected]>; [email protected]<mailto:[email protected]> Sent: Saturday, January 19, 2013 4:24 PM Subject: Re: [Sepsis Groups] changing the sepsis screen for flu season 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]<mailto:[email protected]>> To: Ron Daniels <[email protected]<mailto:[email protected]>> Cc: sepsisgroups <[email protected]<mailto:[email protected]>>; Sue Beswick <[email protected]<mailto:[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]<mailto:[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]<mailto:[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]<mailto:[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]<mailto:[email protected]> >>> >>> >>> >>>From: >>>[email protected]<mailto:[email protected]> >>> >>>[mailto:[email protected]<mailto:[email protected]>] >>> On Behalf Of Sara Valentine >>>Sent: Thursday, January 03, 2013 3:53 PM >>>To: 'Sue Beswick'; >>>[email protected]<mailto:[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]<mailto:[email protected]>> [mailto:[email protected]<mailto:[email protected]>] On Behalf Of Sue Beswick >>> >>>Sent: Wednesday, January 02, 2013 2:21 PM >>>To: >>>'[email protected]<mailto:[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. If you are not the intended recipient, you are hereby notified >>>that any disclosure, copying, distribution, or action taken in reliance on >>>the contents of these documents is strictly prohibited. If you have received >>>this email in error, please notify the sender immediately to arrange for >>>return of these documents. >>> >>>________________________________ >>> >>>This e-mail and any attachments to it are confidential and are intended >>>solely for use of the individual or entity to whom they are addressed. If >>>you have received this e-mail in error, please notify the sender immediately >>>and then delete it. If you are not the intended recipient, you must not >>>keep, use, disclose, copy or distribute this e-mail without the author's >>>prior permission. 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]<mailto:[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]<mailto:[email protected]> >http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org -------------- next part -------------- An HTML attachment was scrubbed... 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