I guess I am still confused on the shock clock. I was under the impression from the specification manual that we used the point at which the patient became hypotensive and/or lactic acid >4 as the septic shock presentation time.
Questions: 1. The patient develops severe sepsis at 0300 and BP drops to 80/40 at 0600. 30ml/kg was given and completed at 0730. BP 60/40 at 0830. Is the presentation time 0830? 2. If the presentation time is 0830, then we have already completed the 3 hour bundle prior to presentation and have until 1430 to complete the 6 hour bundle, correct? 3. What would presentation time be if the patient did not receive the full 30ml/kg? BP 80/40 0600, received 20ml/kg at 0730 and Levophed gtt was initiated at 0830 for BP 60/40. MD documents septic shock at 1500. Is the presentation time 0830 with the hypotension following fluids or 1500 when the MD documents septic shock since the full amount of fluids were not received to determine if the patient truly had persistent hypotension? 4. The patient develops severe sepsis at 0300. Lactic acid 5.0 at 0600 (not hypotensive). 30ml/kg is completed at 0830. Is the presentation time 0600 or 0830? Thanks Jennifer Osburn, RN, BSN Quality and Accreditation St. Mary's Medical Center [email protected] -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Townsend, Sean, M.D. Sent: Friday, September 25, 2015 12:12 PM To: Parker, Erin Cc: [email protected] Subject: Re: [Sepsis Groups] Clock and Fluids In your scenario the shock clock starts at 14:00. No "second" bolus is required (but you may want to give more fluids). SSC supports the CMS measure for US hospitals. We have not removed all references to triage time and other changes as we have yet to clear these changes with our European counterparts, but it's in the works. On Sep 25, 2015, at 10:04 AM, Parker, Erin <[email protected]<mailto:[email protected]>> wrote: Just when I think I have a handle on the shock clock, I still don’t think I completely understand. Question: For a pt with severe sepsis with hypotension: EX: hypotension at 1200 given 30ml/kg, fluids completed at 1300, MAP at 1400 was 55, is 1400 when shock clock starts, and do you complete another 30ml/kg bolus? Question: SSC stills has triage time for clock to being if in ED, is this correct? Erin K. Parker RN, BSN, ACM | Infection Control Genesys Regional Medical Center | One Genesys Parkway | Grand Blanc, MI 48439 Phone: 810.606.5093| Fax: 810-606-5495 | [email protected]<mailto:[email protected]> | www.genesys.org<http://www.genesys.org/> CONFIDENTIALITY NOTICE: This email message and any accompanying data or files is confidential and may contain privileged information intended only for the named recipient(s). If you are not the intended recipient(s), you are hereby notified that the dissemination, distribution, and or copying of this message is strictly prohibited. If you receive this message in error, or are not the named recipient(s), please notify the sender at the email address above, delete this email from your computer, and destroy any copies in any form immediately. Receipt by anyone other than the named recipient(s) is not a waiver of any attorney-client, work product, or other applicable privilege. _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[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 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. _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
