Jeffrey, I'm not bickering! I agree that the Rivers protocol and SSC Resusc Bundle have saved countless lives: I'm an SSC zealot!
I also agree strongly that extensive academic debate is sometimes the enemy of rapid progress (infuriates me on a daily basis) and that this can bring about harm by omission. I was simply saying that there is room for pragmatism in application of both the Bundle and Rivers' protocol (as intimated by the two-tiered grading of EGDT elements in the 2008 update). I think if we're going to bring everyone with us we need to embrace this and accept that folks will want to adopt local variations in implementation. My message, which I might have worded poorly, is to go deliver the Bundle, do it reliably and consistently and with core goals consistent with SSC recommendations, but do it in a way which best suits the needs of your local patients. Does this make more sense? I'm guessing even the great man himself wouldn't claim to argue that he knows that, eg, ScvO2 >70% is better than >71%.. Kind regards Ron On Tue, Dec 20, 2011 at 5:19 PM, Jeffrey R Hanlon RN <[email protected] > wrote: > And what did those healthcare professionals do before the protocol. They > applied what they knew and what they thought was best for the patient with > the information at hand. Once the protocol was developed it gave a > consistent model to follow that saved lives. I have watched it work on many > occassions. > Each physician still has the ability to use his or her knowledge base and > experience to treat the patient but having a tested model that can be > initiated even by prehospital personnel will, in my humble opinion continue > to save the patients from an ever increasing killer. > The longer we continue to bicker and pick it apart the more people are > going to succumb to sepsis. We need to all be on the same page. > > > Jeffrey R Hanlon RN > Stamp Out Sepsis > > > > > -----Original Message----- > From: [email protected] > To: Jeffrey R Hanlon RN **; sepsisteam **; Joan.Greene ** > Cc: sepsisgroups ** > Sent: Tue, Dec 20, 2011 6:22 am > Subject: RE: [Sepsis Groups] SSC guidelines > > Ron, I agree with you. It is not any individual part of the protocol > that makes the difference. It is early recognition, appropriate antibiotic > and fluid management altogether. In addition, the end goal must be tailored > to the individual patient. > > > > Jeffrey, protocols do not save lives, health care professionals do. > > > > *Riad Cachecho**,MD**,MBA* > > *Director of Trauma* > > *Crozer** Chester Medical Center* > > *One Medical Center Boulevard* > > *Vivaqua Pavillion, suite 440* > > *Upland**, PA 19013* > > *610-447-6090* > > THIS EMAIL CONTAINS CONFIDENTIAL INFORMATION. ANY INFORMATION CONTAINED IS > USED FOR PEER REVIEW PURPOSES ONLY. > ------------------------------ > > *From:* [email protected] [ > mailto:[email protected]<[email protected]?>] > *On Behalf Of *Jeffrey R Hanlon RN > *Sent:* Monday, December 19, 2011 10:27 PM > *To:* [email protected]; [email protected] > *Cc:* [email protected] > *Subject:* Re: [Sepsis Groups] SSC guidelines > > > > All I can say is the protocol has and continues to save lives! > > Jeffrey R Hanlon RN > Stamp Out Sepsis > > > > > -----Original Message----- > From: [email protected] > To: Joan Greene > Cc: sepsisgroups > Sent: Thu, Dec 15, 2011 3:46 am > Subject: Re: [Sepsis Groups] SSC guidelines > > Hi Joan, > > > > My views (for what they're worth): > > > > - Key issue is ScvO2 as sole indicator of O2 delivery. Agree other > modalities of assessment of volume responsiveness and O2 delivery have > equal or greater role, but I believe answer lies in a colleciton of > clinical information: dangerous for anyone to run too fast with a single > modality! > - CVC is necessary for a majority of these patients for pressors/ > tropes anyway. The authors don't argue against CVC but against > over-reliance on CVP and ScvO2. Pragmatically, we need to build a larger > picture: we assimilate informaiton from multiple sources to build our > picture > - Slight concerns with article. It confuses septic shock with severe > sepsis which is not helpful or appropriate (see criteria fig 1). > Referencing is somewhat author-centric > > > > *Summary*: Don't let this hold you back. EDs get excited about EGDT and > forget the basics. Let's try not to get hung up on individual modalities > (esp until we have ARISE/ ProCESS/ ProMISe) but recognise and intervene > quickly using the monitoring strategies we have to hand and an assimilation > of information. Rivers' protocol is good- and prob better than random care- > but no-one ever suggested it was the ultimate answer! > > > > What do others think? > > > > kind regards > > > > Ron > > > > On Mon, Dec 12, 2011 at 4:37 AM, Joan Greene <[email protected]> > wrote: > > > > Has anyone else received push-back in their early goal-directed therapy > protocols after the attached article was published? We recently > implemented the SSC guidelines for EGDT in our hospital by using a > screening algorithm to activate a sepsis response team. The response team > follows the 6-hour bundle. Now, we have some physicians who want to > revisit the need for a central line based on this article. The bundle > cannot be followed without a central line to measure the CVP and/or ScvO2 > monitoring. I would appreciate any comments. Thank you. > > > > Joan Greene > > San Diego > > > > > > -- > > Dr Ron Daniels > > > > > > *Suspect Sepsis: save someone's life today.* > > > > *Sign our e-petition at http://epetitions.direct.gov.uk/petitions/19602* > > > > Fellow: NHS Improvement Faculty > > Chair: Surviving Sepsis Campaign United Kingdom > > Chair: United Kingdom Sepsis Group > > Member of Congress: Global Sepsis Alliance > > Survive Sepsis Programme Director > > First Trustee: U.K Sepsis Trust > > > > > > *Twitter: @sepsisuk* > > > > _______________________________________________ > > Sepsisgroups mailing list > > [email protected] > > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > > -- Dr Ron Daniels *Suspect Sepsis: save someone's life today.* * * *Sign our e-petition at **http://epetitions.direct.gov.uk/petitions/19602* * * Fellow: NHS Improvement Faculty Chair: Surviving Sepsis Campaign United Kingdom Chair: United Kingdom Sepsis Group Member of Congress: Global Sepsis Alliance Survive Sepsis Programme Director First Trustee: U.K Sepsis Trust *Twitter: @sepsisuk*
_______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
