Lee, All a bit too much thinking and clever calculations for me, as an ED nurse. My teaching and practice includes the UK Sepsis bundle that for all patients presenting in sepsis (any level) a Blood gas to assess oxygenation and lactate is mandatory. This can be venous but certainly for any chest sepsis this must be an arterial one. Equally, I normally teach that for severe sepsis I am looking for signs of failure outside the primary source of infection. I would expect the SaO2 to be low (without oxygen) and some signs of resp. failure in a pneumonia, so I would be looking for other signs that the infection/hypo-perfusion was affecting the wider organs, so raised lactate, abnormal renal function, level of consciousness etc. This seems like the most understandable and teachable distinction of sepsis vs severe sepsis. Might be a bit simplistic for the purest's amongst us, but we are trying to provide a consistent process of thinking and reasoning for all levels of staff so patients can be identified as early as possible and treatment initiated. Hope its useful.
Heather McClelland Nurse Consultant - Emergency Care ________________________________ From: [email protected] [mailto:[email protected]] On Behalf Of Maddox, Lee Sent: 11 February 2014 15:06 To: '[email protected]' Subject: [Sepsis Groups] Acute Hypoxic Respiratory Failure Definition for Severe Sepsis Diagnosis in Pneumonia To all I Have a question regarding determining severe sepsis with pneumonia. Often, patients who present with pneumonia do not get a blood gas. So, if you are utilizing the criteria for hypoxic respiratory failure with pneumonia: * Acute lung injury with PaO2/FIO2 < 200 in the presence of pneumonia as infection source (If there is another accepted definition for acute hypoxic respiratory failure in a non Intubated patient I'd love to see it by the way) Doing the math, you would need a person to come in with a room air PaO2 of 42 to meet this definition. * (FIO2)200 = PaO2 so (0.21)200 = 42 According to my extraordinary RT's conversion sheet, at a pH of 7.4 this would be a saturation of 77% on room air. At 7.2 pH it would be a room air sat of 66% So I would guess the ER would get a gas on that person anyway but, if someone comes in with pneumonia and has a room air sat of 85%: 1. Would you call this an organ failure or would you stick to the above definition? 2. Is there another definition utilizing oxygen saturations in pneumonia to call something hypoxemic respiratory failure and thus SEVERE SEPSIS Thanks, Lee Lee A. Maddox, M.D. Medical Director of Pulmonary Services, Wellspan Division Chief Pulmonary and Critical Care Medicine, Wellspan Site Director, Wellspan Lung, Sleep, and Critical Care Phone 717-851-2939 Pager 717-751-9517 Fax - 717-851-6446 ________________________________ CONFIDENTIALITY NOTICE: This email may contain confidential health information that is legally privileged. This information is intended for the use of the named recipient(s). The authorized recipient of this information is prohibited from disclosing this information to any party unless required to do so by law or regulation 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 this email is strictly prohibited. If you receive this e-mail message in error, please notify the sender immediately to arrange disposition of the information.. ______________________________________________________________________ This e-mail has been scanned by Verizon Managed Email Content Service, using Skeptic(tm) technology powered by MessageLabs. For more information on Verizon's Managed Email Content Service, visit http://www.verizonbusiness.com. ______________________________________________________________________ ________________________________ Disclaimer: This is an e-mail from Calderdale and Huddersfield NHS Foundation Trust (the Trust). This message and any files transmitted with it are confidential. If you are not the intended recipient any reading, printing, storage, disclosure, copying or any other action taken in respect of the e-mail is prohibited and may be unlawful. If you have received this message in error, please notify the sender immediately by using the reply function and then delete what you have received. The Trust accepts no responsibility for any changes made to this message after it has been sent by the original author. The views or opinions contained herein do not necessarily represent the views of the Trust. This e-mail or any of its attachments may contain data that falls within the scope of the Data Protection Acts. You must ensure that any handling or processing of such data by you is fully compliant with the terms and provisions of the Data Protection Act 1984 and 1998. Please note that as the sender of this email is a Public Authority, the contents of any email received in response, even if marked confidential, may be disclosed in accordance with the Freedom of Information Act 2000 unless legally exempt.
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