Good Luck & Safe travels to you and your team in Haiti. [Description: sig1]
Cliff Peebles, RN<outbind://23-000000004315E22FCF058346A5246C72F39E671307000CBF5C420BD8AD4AAEDED774BD4A240F000003C2DFC000000CBF5C420BD8AD4AAEDED774BD4A240F000007DE01060000/[email protected]> Northwestern Medical Center<http://www.northwesternmedicalcenter.org/> Intensive Care Unit 133 Fairfield Street<http://www.mapquest.com/maps?address=133+Fairfield+St&city=Saint+Albans&state=VT&zipcode=05478-1726&country=US> Saint Albans, Vermont 05478<http://www.mapquest.com/maps?address=133+Fairfield+St&city=Saint+Albans&state=VT&zipcode=05478-1726&country=US> Phone 802-524-1039 / FAX 802-524-1204 Statement of Confidentiality This message and any attachments are from NMC and intended only for the addressee(s). The information contained may include privileged information. Unauthorized review, forwarding, printing, copying or distribution is strictly prohibited. If you have received this message in error, please delete it and notify the sender. Thank you. From: [email protected] [mailto:[email protected]] On Behalf Of [email protected] Sent: Tuesday, March 11, 2014 6:13 AM To: Ron Elkin Cc: [email protected] Subject: [Sepsis Groups] Sepsis Care in third world countries Good morning all, I'll be traveling to Haiti in May and I was wondering if anyone out there has examples/protocols for care of sepsis patients in those regions where access to resources is sparse. I know that's been an aim of SSC moving forward. Obviously, the technology in these areas would likely not permit measurement of CVPs/ScVO2, etc, but front-loading of fluids and early antibiotics may be feasible with some education of local practitioners. Any ideas would be much appreciated. Thanks, Rich Levrault, DO ________________________________ From: "Ron Elkin" <[email protected]<mailto:[email protected]>> To: "Karin Molander" <[email protected]<mailto:[email protected]>> Cc: [email protected]<mailto:[email protected]> Sent: Sunday, March 9, 2014 2:12:01 PM Subject: Re: [Sepsis Groups] Lactates of 2 or greater being discharged or admitted to the floor I believe the SSC data base documents a 23% mortality rate for severe sepsis with normal lactate, normal BP at presentation. There are a number of observational studies in similarly ill severe sepsis patients, including that of SSC, documenting a mortality penalty associated with triage to the floor before transfer to ICU as compared to triage directly to ICU. I'm aware of no studies showing equivalent or better outcomes for severe sepsis on telemetry on the floors as compared to ICU, even for the not-so-ill patients. I'm aware of no studies randomizing patient assignments to ICU, step-down, telemetry, floors and home, and certainly no publications advocating home. In contrast, the mortality rate at Intermountain Health was 8.7% - 9.7% for combined septic shock and severe sepsis (lactates 2.0-3.9), with triage to ICU, Miller RR et al. AJRCCM July 2013. I'm not sure triage to telemetry adds much outcome benefit to to placement on the floors. The outcome benefits of ICU and step-down are perhaps more likely related to greater frequency of vital signs monitoring (Q1-2H vs Q4H on floors and many telemetry units) as well as triage to areas where RNs and MDs are much more familiar with recognition and management of severe sepsis. Based on the above, it seems prudent to triage all patients with severe sepsis to ICU or stepdown whenever permitted by bed availability. While lactate elevation and/or hypotension are important signs of mortality risk, their absence hardly portends a benign outcome. Ron Elkin, MD California Pacific Medical Center San Francisco On Thu, Mar 6, 2014 at 8:38 AM, Karin Molander <[email protected]<mailto:[email protected]>> wrote: Does anyone have data/article references regarding lactates of 2 being sent home or admitted to a floor bed rather than Telemetry bed? -- Karin H. Molander MD Mills-Peninsula Hospital Sutter _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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