Hi Jeannine, Good question...and I am interested to see the other replies. Personally, I do not agree that obtaining the required labs would increase time or waste resources, though. There are many types of sepsis presentation that, on the surface, seem to have an obvious cause (e.g. some pneumonias, urinary tract infections, cellulitis) - but the standard-of-care expectation is still to follow the steps of the bundle.
In all of the scenarios you used as examples there would have been some baseline labs drawn...adding a lactate/Bcx to those shouldn't add any time. Some radiological evaluation (i.e. CT) is also needed in all of those examples and labs can be "cooking" while that is taking place. As for wasted resources, lactate could provide useful information about hypoperfusion in patients who have been managing to compensate and maintain their blood pressure and to serve as a baseline to help track progress after the offending part has been dealt with surgically. The benefit of blood cultures, though, might be a bit less clear. It seems to have some benefit, howeever, in '"clinically toxic" or immunocompromised patients (see here - Executive Summary, point #18: http://cid.oxfordjournals.org/content/50/2/133.full.pdf+html) and I would have thought that anyone meeting criteria for severe sepsis or septic shock would appear "clinically toxic". Let's see what the others have to say... Sam -- Sam Farrell, RN CCRN Intensivist Program Manager West Coast Critical Care Specialists office: 805.988.7004 fax: 805.988.7101 cell: 805.444.3730 wccriticalcare.com *CONFIDENTIALITY NOTICE : This message and any included attachments are intended only for the addressee and may contain confidential information belonging to the sender that is legally protected. Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please promptly delete this message and notify the sender of the delivery error by e-mail. Thank you.* On Wed, Jun 3, 2015 at 1:11 PM, Gerolamo, Jeannine < [email protected]> wrote: > Does anyone know how the sepsis core measures will apply to patients > with obvious need for emergency surgery (ex. Perforated viscus, infected > diverticulitis, perforated appendix). Will we still be expected to obtain > blood cultures, lactic acid when we know the cause of sepsis? Could be an > enormous delay in treatment and poor utilization of resources. Thanks, > Jeannine > > > > > > > > > > > > ------------------------------ > > ****************** CONFIDENTIALITY NOTICE ********************** > > This e-mail contains LEGALLY PRIVILEGED AND CONFIDENTIAL INFORMATION > intended only for the use of the recipient named above. If you are not > the intended recipient, you are hereby notified that any dissemination or > copying of this e-mail is strictly prohibited. If you have received this > e-mail in error, please notify the transmitting hospital by telephone or > e-mail and delete the original e-mail received in error. > > THIS INFORMATION HAS BEEN DISCLOSED TO YOU FROM RECORDS WHOSE > CONFIDENTIALITY IS PROTECTED BY STATE AND FEDERAL LAW. ANY FURTHER > DISCLOSURE, COPYING, DISTRIBUTION OR ACTION TAKEN IN RELIANCE ON THE > CONTENTS OF THESE DOCUMENTS WITHOUT THE PRIOR WRITTEN CONSENT OF THE > PERSON TO WHOM IT PERTAINS IS PROHIBITED. YOU ARE REQUIRED TO DESTROY > THE INFORMATION AFTER THE STATED NEED HAS BEEN FULFILLED. > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > >
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