Sean, My answer is NO...they do not all need ICU. I think it is very patient specific and determined by "how close to the edge" they are....for lack of a better way to say it right now. The numbers do not ALWAYS reflect the patient status....We put some on the medical unit that seem to be stable after ED treatment....sure, a tiny few may end up being RRT'ed later...but for the most part....those with SS that are admitted to the floor instead of ICU seem to be OK once they get the antibiotic and fluids in ED and stabilize rather quickly. I would never treat it as a black and white decision with strictly numbers and test results. One has to see the patient and know the patient...including co-morbidities and response to the treatment you have initiated already. Just my 2 cents.
-----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of Townsend, Sean, M.D. Sent: Friday, March 15, 2013 2:32 AM To: '[email protected]' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality & Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email [email protected] office (415) 600-5770 fax (415) 600-1541 _______________________________________________ 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
