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]> 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]> > 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]> 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] >>> >>> >>> >>> From: [email protected] >>> [mailto:[email protected]] On Behalf Of Sara >>> Valentine >>> Sent: Thursday, January 03, 2013 3:53 PM >>> To: 'Sue Beswick'; [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]] On Behalf Of Sue >>> Beswick >>> >>> Sent: Wednesday, January 02, 2013 2:21 PM >>> To: '[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] >> 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] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
_______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
