We are still having a hard time getting our docs to administer the initial 30ml/kg bolus. One of the arguments is body weight. Is there anyone that uses an adjusted body weight in the obese patient for the initial fluid bolus. If so, at what point to you start using an adjusted body weight? Thanks Chelsea Bibelhauser RN, BSN
-----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of [email protected] Sent: Thursday, February 06, 2014 9:58 AM To: [email protected] Subject: Sepsisgroups Digest, Vol 95, Issue 4 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. Pediatric Sepsis management (Osburn, Jennifer R.) 2. Re: flu and choice of antibiotic or not to give one? (Karin) 3. Re: Sepsisgroups Digest, Vol 95, Issue 1 (Terry Clemmer) ---------------------------------------------------------------------- Message: 1 Date: Wed, 5 Feb 2014 12:01:31 -0500 From: "Osburn, Jennifer R." <[email protected]> To: <[email protected]> Subject: [Sepsis Groups] Pediatric Sepsis management Message-ID: <532f01aabba3ef489e25d8889a0e694801ae3...@smmc-exchange.st-marys.org> Content-Type: text/plain; charset="utf-8" Our facility is looking at developing a pediatric sepsis protocol. Thru research, I have found medical management criteria for development of pediatric sepsis, severe sepsis and septic shock. I have not been able to locate anything regarding early management through treatment of SIRS in the pediatric population. Does anyone have a pediatric protocol for SIRS that you would be willing to share? Thanks Jennifer Osburn, RN, BSN Quality and Accreditation St. Mary's Medical Center [email protected] <mailto:mailt:[email protected]> Important Notice: This e-mail message and any attachments are from the above sender at St. Mary?s Medical Center and are intended solely for the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you are not the intended recipient of this communication or the employee or agent responsible for delivering the message to the intended recipient, or if it has been sent to you in error, please notify the sender immediately. Do not examine, review, use, disclose, deliver, distribute, reproduce or take any action in reliance on it and immediately delete the message and any attachments. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140205/64fbf578/attachment.htm> ------------------------------ Message: 2 Date: Wed, 5 Feb 2014 09:52:55 -0800 From: Karin <[email protected]> To: "<[email protected]>" <[email protected]> Cc: "<[email protected]>" <[email protected]>, "<[email protected]>" <[email protected]> Subject: Re: [Sepsis Groups] flu and choice of antibiotic or not to give one? Message-ID: <[email protected]> Content-Type: text/plain; charset=us-ascii Along that lines, would vancomycin for cellulitis be considered a "fail"as it is not a "broad spectrum" antibiotic? Karin Sent from my iPhone > On Feb 4, 2014, at 9:22 AM, <[email protected]> wrote: > > I would think not, if it's a viral sepsis. Treatment with Tamiflu is > appropriate care for it, and it isn't bacterial. > > > Susan M. McKinney, RN > Clinical Quality Coordinator-Sepsis > Clinical Documentation Specialist > Rapid City Regional Hospital > 605-719-4428 > 605-484-7381 > [email protected] > > > > -----Original Message----- > From: [email protected] > [mailto:[email protected]] On Behalf Of Sue Beswick > Sent: Monday, February 03, 2014 2:33 PM > To: '[email protected]' > Subject: Re: [Sepsis Groups] flu and choice of antibiotic or not to give one? > > With our severe sepsis flu admits, a number are being admitted without a > broad spectrum antibiotics - only getting tamiflu. > We aren't using the sepsis database yet but hope to soon - would that be a > fail? > > Thanks > Sue > > Sue Beswick RN, MS, CCNS, CCRN > Clinical Nurse Specialist - MSICU > Greenville Health System > 701 Grove Road l Greenville, SC 29605 > Office: 864-455-4884 > > If not this, then what? If not now, then when? If not me, then who? > > - John Lewis > > > -----Original Message----- > From: [email protected] > [mailto:[email protected]] On Behalf Of > [email protected] > Sent: Friday, January 31, 2014 3:08 PM > To: [email protected] > Subject: Sepsisgroups Digest, Vol 94, Issue 8 > > Send Sepsisgroups mailing list submissions to > [email protected] > > To subscribe or unsubscribe via the World Wide Web, visit > > https://urldefense.proofpoint.com/v1/url?u=http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=264ab120a21b69ffdb5400be85897bba2d955544ecbcdf5b4cdba11188b07586 > > 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. Sepsis tool APACHE question (Dian Nuxoll) > 2. severe sepsis screening tool question (Dian Nuxoll) > > > ---------------------------------------------------------------------- > > Message: 1 > Date: Thu, 30 Jan 2014 18:00:54 +0000 > From: Dian Nuxoll <[email protected]> > To: "'[email protected]'" > <[email protected]> > Subject: [Sepsis Groups] Sepsis tool APACHE question > Message-ID: > > <943b1cfe9fc3db41ac39532172f66b1b71376...@exchmail3.evergreenhealthcare.org> > > Content-Type: text/plain; charset="us-ascii" > > Under "oxygenation", am I correct to assume this pertains to intubated > patients only? > > Under "FIO2 0.5 or more, A-aDO"-is that the same as A-a Grad? What is this > exactly? > "< .05, use PAo"-is this the same as PO2?, if not, what is it and how do I > find it? > > Appreciate your help! > > > Dian Nuxoll, RN, BSN Clinical Quality Analyst - Quality Management > 425.899.2359 I EvergreenHealth MS-62, 12040 NE 128th St., Kirkland, WA 98034 > Follow EvergreenHealth on > Facebook<https://urldefense.proofpoint.com/v1/url?u=http://www.facebook.com/evergreenhospital.org&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=3b35de904851eb91e3d45ca634838bab8ba9ca34fc55743cfae67a8929fd16cb> > and > Twitter<https://urldefense.proofpoint.com/v1/url?u=http://twitter.com/&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=6b0144da39452d8e26e1b10886d93189488bb43183633961d63b1110616485b1> > | > www.evergreenhealthcare.org<https://urldefense.proofpoint.com/v1/url?u=http://www.evergreenhealthcare.org/&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=1156521227ee03e04b5cf1bb2a2ec9091e2b9f45df0e862de2bc844655629104> > > > Please note: My e-mail address has changed to [email protected] > > > DISCLAIMER: > EvergreenHealth Confidentiality Notice: This email message, including any > attachments, is for the sole use of the intended recipient(s) and may contain > confidential and privileged information. Any unauthorized review, use, > disclosure or distribution is prohibited. If you are not the intended > recipient, please contact the sender by e-mail and destroy all copies of the > original message or you may call EvergreenHealth in Kirkland, WA U.S.A at > (425)899-1740. > -------------- next part -------------- > An HTML attachment was scrubbed... > URL: > <https://urldefense.proofpoint.com/v1/url?u=http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140130/5eef97f0/attachment.html&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=55ae85e2df0b3327c455d1ed185f17159ae6cb5ee7775446035d3cc59fa8ed59> > -------------- next part -------------- > A non-text attachment was scrubbed... > Name: Picture (Device Independent Bitmap) 1.jpg > Type: image/jpeg > Size: 2471 bytes > Desc: Picture (Device Independent Bitmap) 1.jpg > URL: > <https://urldefense.proofpoint.com/v1/url?u=http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140130/5eef97f0/attachment-0001.jpg&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=74f40e1e8bb8392e5abe2e4bb5938c0e448a3256f5d4d273db9b57e85bb75f66> > > ------------------------------ > > Message: 2 > Date: Thu, 30 Jan 2014 23:00:41 +0000 > From: Dian Nuxoll <[email protected]> > To: "'[email protected]'" > <[email protected]> > Subject: [Sepsis Groups] severe sepsis screening tool question > Message-ID: > > <943b1cfe9fc3db41ac39532172f66b1b71376...@exchmail3.evergreenhealthcare.org> > > Content-Type: text/plain; charset="us-ascii" > > Regarding #3. On screen 2: in evaluating the acute lung injury, does the > patient have to be intubated for this or just have an ABG? > > Dian Nuxoll, RN, BSN Clinical Quality Analyst - Quality Management > 425.899.2359 I EvergreenHealth MS-62, 12040 NE 128th St., Kirkland, WA 98034 > Follow EvergreenHealth on > Facebook<https://urldefense.proofpoint.com/v1/url?u=http://www.facebook.com/evergreenhospital.org&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=3b35de904851eb91e3d45ca634838bab8ba9ca34fc55743cfae67a8929fd16cb> > and > Twitter<https://urldefense.proofpoint.com/v1/url?u=http://twitter.com/&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=6b0144da39452d8e26e1b10886d93189488bb43183633961d63b1110616485b1> > | > www.evergreenhealthcare.org<https://urldefense.proofpoint.com/v1/url?u=http://www.evergreenhealthcare.org/&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=1156521227ee03e04b5cf1bb2a2ec9091e2b9f45df0e862de2bc844655629104> > > > Please note: My e-mail address has changed to [email protected] > > > DISCLAIMER: > EvergreenHealth Confidentiality Notice: This email message, including any > attachments, is for the sole use of the intended recipient(s) and may contain > confidential and privileged information. Any unauthorized review, use, > disclosure or distribution is prohibited. If you are not the intended > recipient, please contact the sender by e-mail and destroy all copies of the > original message or you may call EvergreenHealth in Kirkland, WA U.S.A at > (425)899-1740. > -------------- next part -------------- > An HTML attachment was scrubbed... > URL: > <https://urldefense.proofpoint.com/v1/url?u=http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140130/300630c5/attachment-0001.htm&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=36a41922cae3b4aa81445b4bba1d5f3564e927e809b2eba2195d4c0d5a64b3c6> > -------------- next part -------------- > A non-text attachment was scrubbed... > Name: Picture (Device Independent Bitmap) 1.jpg > Type: image/jpeg > Size: 2471 bytes > Desc: Picture (Device Independent Bitmap) 1.jpg > URL: > <https://urldefense.proofpoint.com/v1/url?u=http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140130/300630c5/attachment-0001.jpg&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=20dfbbc15d5e77e08d6ab2541074fb963d4387aa21d3e9175748271c590f2613> > > ------------------------------ > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > https://urldefense.proofpoint.com/v1/url?u=http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=264ab120a21b69ffdb5400be85897bba2d955544ecbcdf5b4cdba11188b07586 > > > End of Sepsisgroups Digest, Vol 94, Issue 8 > ******************************************* > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > https://urldefense.proofpoint.com/v1/url?u=http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org&k=gvSHeaFBHkYwSc4JvWghxQ%3D%3D%0A&r=egaKiPQ%2Brdwqr5Y0ugXX3GDQH6Tbc%2BHQdD8DIzjfxAc%3D%0A&m=KvAemLTet8mz2yjzvJZRPFRMOYdvXEvu2d05rm%2BJ1Dc%3D%0A&s=264ab120a21b69ffdb5400be85897bba2d955544ecbcdf5b4cdba11188b07586 > > ---------------------------------------------------------------------- > Regional Health's mission is to provide and support health care excellence in > partnership with the communities we serve. > > Note: The information contained in this message, including any attachments, > may be privileged, confidential, or protected from disclosure under state or > federal laws . If the reader of this message is not the intended recipient, > or an employee or agent responsible for delivering this message to the > intended recipient, you are hereby notified that any dissemination, > distribution, or copying of this communication is strictly prohibited. If you > have received this communication in error, please notify the Sender > immediately by a "reply to sender only" message and destroy all electronic or > paper copies of the communication, including any attachments. > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ Message: 3 Date: Wed, 5 Feb 2014 18:13:27 +0000 From: Terry Clemmer <[email protected]> To: Robyn Haddock Crosswhite <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 95, Issue 1 Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" If the PICC line tip is in the SVC then the sample and CVP measurement is accurate if the wave form is of good quality. We use the NICOM as a substitute for the CVP using the fluid responsiveness as a guide to give or not give more fluid. It is actually better than the CVP. We also use the Cardiac Index rather than the ScvO2 using a normal or high value as being adequate but realizing that if the metabolic rate is high the ScvO2 could still be low. Terry P. Clemmer, MD Director: Critical Care Medicine LDS Hospital Professor of Medicine University of Utah School of Medicine Salt Lake City, Utan 84143 Work Phone: 801-408-3661 Work Fax: 801-408-1668 -----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of Robyn Haddock Crosswhite Sent: Tuesday, February 04, 2014 1:57 PM To: [email protected] Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 95, Issue 1 In a septic shock patient, does a PICC line count as far as for SCVO2 ? Is it accurate and will NICOM suffice to replace CVP monitoring ? Thanks Robyn Crosswhite -----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of [email protected] Sent: Tuesday, February 04, 2014 2:08 PM To: [email protected] Subject: Sepsisgroups Digest, Vol 95, Issue 1 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: flu and choice of antibiotic or not to give one? (Sue Beswick) ---------------------------------------------------------------------- Message: 1 Date: Mon, 3 Feb 2014 21:32:49 +0000 From: Sue Beswick <[email protected]> To: "'[email protected]'" <[email protected]> Subject: Re: [Sepsis Groups] flu and choice of antibiotic or not to give one? Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" With our severe sepsis flu admits, a number are being admitted without a broad spectrum antibiotics - only getting tamiflu. We aren't using the sepsis database yet but hope to soon - would that be a fail? Thanks Sue Sue Beswick RN, MS, CCNS, CCRN Clinical Nurse Specialist - MSICU Greenville Health System 701 Grove Road l Greenville, SC 29605 Office: 864-455-4884 If not this, then what? If not now, then when? If not me, then who? - John Lewis -----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of [email protected] Sent: Friday, January 31, 2014 3:08 PM To: [email protected] Subject: Sepsisgroups Digest, Vol 94, Issue 8 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. Sepsis tool APACHE question (Dian Nuxoll) 2. severe sepsis screening tool question (Dian Nuxoll) ---------------------------------------------------------------------- Message: 1 Date: Thu, 30 Jan 2014 18:00:54 +0000 From: Dian Nuxoll <[email protected]> To: "'[email protected]'" <[email protected]> Subject: [Sepsis Groups] Sepsis tool APACHE question Message-ID: <943b1cfe9fc3db41ac39532172f66b1b71376...@exchmail3.evergreenhealthcare.org> Content-Type: text/plain; charset="us-ascii" Under "oxygenation", am I correct to assume this pertains to intubated patients only? Under "FIO2 0.5 or more, A-aDO"-is that the same as A-a Grad? What is this exactly? "< .05, use PAo"-is this the same as PO2?, if not, what is it and how do I find it? Appreciate your help! Dian Nuxoll, RN, BSN Clinical Quality Analyst - Quality Management 425.899.2359 I EvergreenHealth MS-62, 12040 NE 128th St., Kirkland, WA 98034 Follow EvergreenHealth on Facebook<http://www.facebook.com/evergreenhospital.org> and Twitter<http://twitter.com/> | www.evergreenhealthcare.org<http://www.evergreenhealthcare.org/> Please note: My e-mail address has changed to [email protected] DISCLAIMER: EvergreenHealth Confidentiality Notice: This email message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by e-mail and destroy all copies of the original message or you may call EvergreenHealth in Kirkland, WA U.S.A at (425)899-1740. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140130/5eef97f0/attachment.html> -------------- next part -------------- A non-text attachment was scrubbed... Name: Picture (Device Independent Bitmap) 1.jpg Type: image/jpeg Size: 2471 bytes Desc: Picture (Device Independent Bitmap) 1.jpg URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140130/5eef97f0/attachment-0001.jpg> ------------------------------ Message: 2 Date: Thu, 30 Jan 2014 23:00:41 +0000 From: Dian Nuxoll <[email protected]> To: "'[email protected]'" <[email protected]> Subject: [Sepsis Groups] severe sepsis screening tool question Message-ID: <943b1cfe9fc3db41ac39532172f66b1b71376...@exchmail3.evergreenhealthcare.org> Content-Type: text/plain; charset="us-ascii" Regarding #3. On screen 2: in evaluating the acute lung injury, does the patient have to be intubated for this or just have an ABG? Dian Nuxoll, RN, BSN Clinical Quality Analyst - Quality Management 425.899.2359 I EvergreenHealth MS-62, 12040 NE 128th St., Kirkland, WA 98034 Follow EvergreenHealth on Facebook<http://www.facebook.com/evergreenhospital.org> and Twitter<http://twitter.com/> | www.evergreenhealthcare.org<http://www.evergreenhealthcare.org/> Please note: My e-mail address has changed to [email protected] DISCLAIMER: EvergreenHealth Confidentiality Notice: This email message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by e-mail and destroy all copies of the original message or you may call EvergreenHealth in Kirkland, WA U.S.A at (425)899-1740. -------------- next part -------------- An HTML attachment was scrubbed... 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