With the example of SIRs+, documented infection, and then a lactate >2 or 4, OR any other Lab showing organ dysfunction, does the clock start with the last piece of the puzzle: Example: 2 SIRs + at triage time = 2000 Lactate >2 OR any other lab [Creatinine 2.0 or >, MAP <65, Bilirubin >2, INR >1.5] at 2015 Doctor note indicating infection at 2020
Does the clock start at 2020? Another question I have: what if the patient has Chronic renal failure, is the Creatinine thrown out as organ dysfunction? Is there a rule or guideline to follow in that instance, that ANOTHER organ must show signs of ACUTE dysfunction? Betsy Pesek MN, BSN, RN, CCRN, CPHQ -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Saturday, September 26, 2015 4:46 AM To: [email protected] Subject: Sepsisgroups Digest, Vol 172, 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. Re: Shock clock (CARIANN M DAHLQUIST) 2. Physician/APN/PA Assessment ([email protected]) 3. Re: stroke volume index (Kramer, George C.) ---------------------------------------------------------------------- Message: 1 Date: Fri, 25 Sep 2015 14:13:07 -0500 From: "CARIANN M DAHLQUIST" <[email protected]> To: <[email protected]> Subject: Re: [Sepsis Groups] Shock clock Message-ID: <[email protected]> Content-Type: text/plain; charset="utf-8" Just for clarification purposes- A patient comes in at 2000 with SIRS criteria + documented pneumonia + lactate level of 5.47 = severe sepsis, however wouldn't this also be the time clock for the septic shock due to the lactate level > 4? I was thinking that both severe sepsis and septic shock time clocks would had started at the same time due to the lactate level. Thanks, CariAnn CariAnn Dahlquist RN Quality Management Altru Health System | Grand Forks, ND 701.780.5339 phone | 701.780.1942 fax | [email protected] ( mailto:[email protected]) >>> "Jennifer L Halligan [SJGH]" <[email protected]> 9/23/2015 1:42 PM >>> > Hi Dr. Townsend, I completely understand now the CMS SEP-1 measure ?shock clock? time zero starts when the you have tissue hypoperfusion, evidenced by either initial lactate > 4 or persistent hypotension in the hour after crystalloids fluids given. Am I the only one that was totally mixed up thinking the shock clock started with severe sepsis with hypotension or lactate greater than 4? I feel a little foolish as I posted a few things. I am now cleared up but just wondering if you can help explain if there was/is a difference at all with how the SSC did ?shock clock time zero? and how CMS is doing shock clock time zero. Thank you so much for all your hard work! Jennifer Halligan, RN Quality Review Nurse San Joaquin General Hospital Tel: 209-468-7471 Fax: 209-468-7011 ------------------------------------------------------------------------------------------------------------------- CONFIDENTIAL & PRIVILEGED COMMUNICATION This email and any files transmitted with it are confidential, may contain privileged or copyright information, and are intended solely for the use of the intended recipient. If you are not the intended recipient of this email, you are required to notify the sender immediately and delete this email from your system. You may not copy, distribute or use this email or the information contained in it for any purpose other than to notify the sender. We do not guarantee that this material is free from viruses or any other defects although due care has been taken to minimize the risk. Any views expressed in this message are those of the individual sender, except where the sender specifically states them to be the views of Altru Health System. --------------------------------------------------------------------------------------------------------------------- CONFIDENTIAL & PRIVILEGED COMMUNICATION This email and any files transmitted with it are confidential, may contain privileged or copyright information, and are intended solely for the use of the intended recipient. If you are not the intended recipient of this email, you are required to notify the sender immediately and delete this email from your system. You may not copy, distribute or use this email or the information contained in it for any purpose other than to notify the sender. We do not guarantee that this material is free from viruses or any other defects although due care has been taken to minimize the risk. Any views expressed in this message are those of the individual sender, except where the sender specifically states them to be the views of Altru Health System. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20150925/ccb56adb/attachment-0001.htm> ------------------------------ Message: 2 Date: Fri, 25 Sep 2015 17:25:15 +0000 From: <[email protected]> To: <[email protected]> Subject: [Sepsis Groups] Physician/APN/PA Assessment Message-ID: <b937f26613d6324ca00e6e3e0b43a0261466b...@fwdcwpmsghcmd4a.hca.corpad.net> Content-Type: text/plain; charset="us-ascii" Hello, I want to thank Dr. Townsend for responding to my questions: thank you so much for your well-reasoned response. I have spoken with a few physicians using that line of thinking and it has been effective. Thank you again. Re: critical values: Our facility is also adding Lactic acid >2 mmol/L as a critical value. New Question: We have approved a nurse-driven protocol where, based on our severe sepsis screening tool, a rapid response ICU nurse may call Code Sepsis and order blood cultures, lactic acid, as well as loading doses of Vancomycin and either Zosyn or Merrem. What other facilities have added antibiotics to their nurse-driven protocols, and how have you provided parameters, education, and safety measures (anything beyond the usual)? Would you be willing to share any materials along those lines? Thanks, Gayle Porter RN BSN Brownsville, TX -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20150925/c771d3de/attachment-0001.htm> ------------------------------ Message: 3 Date: Fri, 25 Sep 2015 16:09:20 +0000 From: "Kramer, George C." <[email protected]> To: "Posani, Theresa" <[email protected]> Cc: "<[email protected]> \([email protected]\)" <[email protected]> Subject: Re: [Sepsis Groups] stroke volume index Message-ID: <[email protected]> Content-Type: text/plain; charset="utf-8" Theresa, in theory all of these would have value for assessing perfusion. I don?t believe any have been proven for sepsis. SVI (stroke volume index), SVV (SV variability) and PPV (pulse pressure variability). The first two you need a CO monitor that last one is often built into the vital signs monitor or the CO monitor. or did i missed the question asked. g On Sep 24, 2015, at 11:42 AM, Posani, Theresa <[email protected]<mailto:[email protected]>> wrote: <image001.gif> Anyone using SVI with their sepsis patients regarding fluid resuscitation/management? Do you have protocols that you would share? How long or what are the stopping points to the use of SVI for fluid resuscitation/management? Are you using 250, 500, or 1000 ml? and how often? Thank you Theresa Posani, MS, RN, ACNS-BC, CCRN Med/Surg CNS Sepsis Coordinator (817) 250-3907 office (972) 838-7954 cell [email protected]<mailto:[email protected]> <image002.jpg>A Clinical Nurse Specialist (CNS) is a Masters prepared Advance Practice Registered Nurse whose function is to improve outcomes in patient care. Functioning in five sub roles including:Expert in Clinical Practice, Educator, Leader, Researcher and Consultant, we influence our 3 spheres of practice; Patient Care, Nursing and Systems. ________________________________ The information contained in this message and any attachments is intended only for the use of 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, you are prohibited from copying, distributing, or using the information. Please contact the sender immediately by return e-mail and delete the original message from your system. _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org -------------- next part -------------- An HTML attachment was scrubbed... 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