Is there any clarification for not giving the fluid bolus amount? we still have docs that are resistant to CHF/renal patients getting a large bolus.
Thank you Kathy Davis RN BSN ICU/SDU Nurse Manager (318) 371-3285 Minden Medical Center 1 Medical Plaza Minden, LA 71055 -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Sunday, October 09, 2016 10:57 AM To: [email protected] Subject: [EXTERNAL] Sepsisgroups Digest, Vol 223, Issue 5 WARNING: This email originated outside LifePoint Health’s email system. DO NOT CLICK links or attachments unless you recognize the sender and know the content is safe. Send Sepsisgroups mailing list submissions to [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] You can reach the person managing the list at [email protected] When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." Today's Topics: 1. Re: [EXTERNAL] Re: Sepsisgroups Digest, Vol 222, Issue 8 (Belfi, Karen) ---------------------------------------------------------------------- Message: 1 Date: Thu, 6 Oct 2016 05:57:11 -0400 From: "Belfi, Karen" <[email protected]> To: "'[email protected]'" <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] [EXTERNAL] Re: Sepsisgroups Digest, Vol 222, Issue 8 Message-ID: <[email protected]> Content-Type: text/plain; charset="utf-8" From my understanding, they?ve changed the algorithm a bit. There are 3 questions to assess the need for crystalloid fluids. If you answer yes to any of these, you move on to answer the crystalloid questions. If you answer no to all of them, you are finished abstracting. The questions are initial hypotension, lactate >/= 4, or physician/APN/PA documentation of septic shock. Any of these three instances, when coupled with severe sepsis, require crystalloid fluids. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center 484-476-8092 Pager: 5240 [cid:[email protected]] From: Sepsisgroups [mailto:[email protected]] On Behalf Of phoebe atieno Sent: Wednesday, October 05, 2016 1:35 PM To: [email protected] Subject: [EXTERNAL] Re: [Sepsis Groups] Sepsisgroups Digest, Vol 222, Issue 8 My abstractor''s and I are struggling with the new element, "initial hypotension".Technically this question will only apply to those patients needing the 30ml/kg?Because just being in severe sepsis doesn't require the 30ml/kg.Comments appreciated in advance. Thanks Sent from Yahoo Mail on Android<https://urldefense.proofpoint.com/v2/url?u=https-3A__overview.mail.yahoo.com_mobile_-3F.src-3DAndroid&d=DQMFaQ&c=qqcbk_QeabW4Z7GBhIMNtn_B7aQjktEuWNmUvrzri9o&r=9XT3K_nIvIIF-7Bh2TiB0g&m=xbcbwwAjWT3ljLsiNV6eY207ywgsXQ0oUU3-vS_Obb0&s=E38WJuP3W1zxTRbDs79i8dAoZGJg2wRPNnorRCslwvg&e=> On Sun, Oct 2, 2016 at 9:13 AM, [email protected]<mailto:[email protected]> <[email protected]<mailto:[email protected]>> wrote: Send Sepsisgroups mailing list submissions to [email protected]<javascript:return> To subscribe or unsubscribe via the World Wide Web, visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org<https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=DQMFaQ&c=qqcbk_QeabW4Z7GBhIMNtn_B7aQjktEuWNmUvrzri9o&r=9XT3K_nIvIIF-7Bh2TiB0g&m=xbcbwwAjWT3ljLsiNV6eY207ywgsXQ0oUU3-vS_Obb0&s=TNvQfY-JrQBWTASvfy58YoKvR4NzvumdHaon8lHsOdo&e=> or, via email, send a message with subject or body 'help' to [email protected]<javascript:return> You can reach the person managing the list at [email protected]<javascript:return> When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." Today's Topics: 1. Re: SIRS+organ dysfunction vs. qSOFA/SOFA (Jaehne, Anja Kathrina) 2. Re: SIRS+organ dysfunction vs. qSOFA/SOFA (Rivers, Emanuel) ---------------------------------------------------------------------- Message: 1 Date: Fri, 30 Sep 2016 17:08:47 +0000 From: "Jaehne, Anja Kathrina" <[email protected]<javascript:return>> To: "'[email protected]<javascript:return>'" <[email protected]<javascript:return>> Subject: Re: [Sepsis Groups] SIRS+organ dysfunction vs. qSOFA/SOFA Message-ID: <[email protected]<javascript:return>> Content-Type: text/plain; charset="us-ascii" Please see below some retrospective comparisons regarding Emergency Department Triage assessments in concerns to qSOFA and SIRS criteria (August 2015- June 2016). These values are only in consideration of Triage for q SOFA and SIRS for patients who are retrospectively clearly identified as having either severe sepsis or septic shock. I would not be able to comment on specificity or sensitivity in the larger undifferentiated ED patient population at triage. TRIAGE ED qSOFA (Hypotension SBP< 100 mmHg; Respiratory Rate >/ = 22 breath/ min; Mental status changes) qSOFA 0 or 1 at Triage qSOFA 2 or 3 at Triage All Patients 260/382 (68%) 122/382 (32 %) Severe Sepsis Patients 150/192 (78%) 42/192 (22 %) Septic Shock patients 110/190 (58 %) 80/190 (42 %) The above data for our ED would mean, that if we would do a qSOFA assessment only once at triage and would base further clinical decisions on this, we may miss 58 - 78 % of patients with severe sepsis or septic shock. However qSOFA is not intended as singular assessment ! But I agree with what was said: it does not provide a sensitive initial screening assessment tool for the ED setting. Especially the assessment of mental status changes in the ED setting appears to be difficult particular in patients who are new to the ED, have no family or on certain medications. The GCS is often normal even when other mental alterations may be present but not documented not even recognized in the ED setting! I can see that in the ICU setting it may be easier to recognize mental status changes in patients which are known to the treatment teams. This is often not possible in the ED! TRIAGE ED SIRS (HR > 90 bpm, RR >/=20, Temp <36 C or > 38 C, WBC <4 or > 12 or bandemia >10) 0 or 1 SIRS 2 or more SIRS All Patients 48/382 (13 %) 334/382 (87 %) Severe Sepsis Patients 27/192 (14 %) 165/192 (86 %) Septic Shock Patients 21/190 (11 %) 169/190 (89 %) When we use TRIAGE SIRS criteria on the same patients who were assessed with qSOFA in the ED, and which have been later by chart review confirmed to have severe sepsis or septic shock, we are less likely to underestimate the potential risk of sepsis in these patients. My five cents: The qSOFA may be a tool for the continued ICU screening for septic patients. It may be not such a good tool in the ED triage setting. >From our observational data it appears to me that SIRS criteria do exactly what Dr Bone had in mind: Identify patients with potential sepsis EARLY. SIRS criteria are not bulled proof, but they currently appear at ED triage the better initial tool to use to use when screening for patients at risk for severe sepsis or septic shock! Hopefully we will have further data soon to have a more prospective validation of qSOFA as a screening tool for sepsis in the ED! Maybe qSOFA performs better in the ICU!? Anyone what to share their data? Kathrina Anja Kathrin Jaehne, MD Clinical Research Coordinator Department of Emergency Medicine Henry Ford Hospital, Detroit MI 48202 [email protected]<javascript:return><mailto:[email protected]<javascript:return>> ________________________________ CONFIDENTIALITY NOTICE: This email contains information from the sender that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This email is intended for use only by the person or entity to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this email, is strictly prohibited. If you received this email in error, please contact the sending party by reply email, delete the email from your computer system and shred any paper copies. Note to Patients: There are a number of risks you should consider before using e-mail to communicate with us. 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URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160930/8652fd08/attachment-0001.htm<https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_pipermail_sepsisgroups-2Dsepsisgroups.org_attachments_20160930_8652fd08_attachment-2D0001.htm&d=DQMFaQ&c=qqcbk_QeabW4Z7GBhIMNtn_B7aQjktEuWNmUvrzri9o&r=9XT3K_nIvIIF-7Bh2TiB0g&m=xbcbwwAjWT3ljLsiNV6eY207ywgsXQ0oUU3-vS_Obb0&s=AEmHcoAfH4PNS9-5EM7P1hfiEiyRN5Bt52tL2i1g2W4&e=>> ------------------------------ Message: 2 Date: Fri, 30 Sep 2016 21:51:08 +0000 From: "Rivers, Emanuel" <[email protected]<javascript:return>> To: "Posani, Theresa" <[email protected]<javascript:return>>, Martie Mattson <[email protected]<javascript:return>>, "Reid, Kathryn S." <[email protected]<javascript:return>> Cc: "Jaehne, Anja Kathrina" <[email protected]<javascript:return>>, "[email protected]<javascript:return>" <[email protected]<javascript:return>> Subject: Re: [Sepsis Groups] SIRS+organ dysfunction vs. qSOFA/SOFA Message-ID: <[email protected]<javascript:return>> Content-Type: text/plain; charset="iso-8859-1" ________________________________ Here is one of the first articles I have seen examining qsofa. ER From: Sepsisgroups <[email protected]<javascript:return>> on behalf of Posani, Theresa <[email protected]<javascript:return>> Sent: Wednesday, September 28, 2016 8:56 AM To: Martie Mattson; Reid, Kathryn S. Cc: [email protected]<javascript:return> Subject: Re: [Sepsis Groups] SIRS+organ dysfunction vs. qSOFA/SOFA Kathryn, I have to agree on the need for further validation with the potentially septic patient. As a sepsis coordinator, I am keeping track of the qSOFA score on patients with the potential for sepsis as they are being transferred into either our intermediate care units or critical care units. Not a consistent parameter to date. I, too, would like to do a more formal research study to validate before implementation. Theresa Theresa Posani, MS, RN, ACNS-BC | Med/Surg CNS/Sepsis Coordinator T 817.250-3907 | M 972.838-7954 [email protected]<javascript:return><mailto:[email protected]<javascript:return>> [https://brandcenter.txhealth.org/logos-templates/Logos/Locations%20<https://urldefense.proofpoint.com/v2/url?u=https-3A__brandcenter.txhealth.org_logos-2Dtemplates_Logos_Locations-2520&d=DQMFaQ&c=qqcbk_QeabW4Z7GBhIMNtn_B7aQjktEuWNmUvrzri9o&r=9XT3K_nIvIIF-7Bh2TiB0g&m=xbcbwwAjWT3ljLsiNV6eY207ywgsXQ0oUU3-vS_Obb0&s=fKfQFbBTjqu0CfZ08uVMfFVU7DZb4VLoXx89-Z56LKg&e=>(Wholly-Owned)/Texas%20Health%20Fort%20Worth/No%20Tagline/RGB-Email%20Signature/THFortWorth-email.jpg] From: Sepsisgroups [mailto:[email protected]<javascript:return>] On Behalf Of Martie Mattson Sent: Tuesday, September 27, 2016 12:40 PM To: Reid, Kathryn S. Cc: [email protected]<javascript:return> Subject: Re: [Sepsis Groups] SIRS+organ dysfunction vs. qSOFA/SOFA I have some concerns with the using the qSOFA to determine necessity for further screening. Since 2006, I have worked with over 15 hospitals in California and Washington to implement screening, and although I never collected any formal data regarding this, it is my stong impression that in the younger, generally healthier population who get septic, change in mental status and decreased blood pressure are more often later signs. The younger person usually has a greater ability to compensate, so these signs don't show up until later in the septic process and we would miss the opportunity for early recognition that has been proven to reduce mortality. I strongly feel that this tool needs to be validated concurrently in the inpatient and outpatient area clinical area before it is use is recommended as the best tool. Martie Mattson, RN, MSN, CNS Critical Care Consultant and Educator Surviving Sepsis Protocol Implementation [email protected]<javascript:return><mailto:[email protected]<javascript:return>> (415) 412-2364 On Thu, Sep 22, 2016 at 10:49 AM, Reid, Kathryn S. <[email protected]<javascript:return><mailto:[email protected]<javascript:return>>> wrote: Has anyone developed a successful marriage of the two screenings yet? If so, I would be very interested in how you are using both effectively to capture the core measure population as well as use the new recommendations. Thanks, Katie Katie Swink Reid, MPH, CPHQ Quality Consultant Performance Improvement & Outcomes Inova Loudoun Hospital 44045 Riverside Parkway Leesburg,VA 20176 T 703-858-6367<tel:703-858-6367> | [email protected]<javascript:return><mailto:[email protected]<javascript:return>> This communication may contain confidential and/or privileged information. 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