A patient with lactate 4 is defined as septic shock, this has been a major point of contention for years for providers who don't feel the need to put in lines in these patients to measure CVP/ScV02. Especially for those that "dont look septic". I know that is the case in my ICU. Up until the past couple years we also defined hypotension with SIRS and infection as septic shock PRIOR to fluid bolus, we have changed our definition to comply with Surviving Sepsis guidelines Dan
Daniel Gerard RPh Critical Care Pharmacist McLaren Northern Michigan 231-487-4770 FAX: 231-487-4817 ________________________________________ From: Sepsisgroups <[email protected]> on behalf of [email protected] <[email protected]> Sent: Thursday, February 11, 2016 5:00 PM To: [email protected] Subject: Sepsisgroups Digest, Vol 191, 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. defining septic shock ([email protected]) 2. Septic shock presentation ([email protected]) ---------------------------------------------------------------------- Message: 1 Date: Tue, 9 Feb 2016 15:06:24 +0000 From: <[email protected]> To: <[email protected]> Subject: [Sepsis Groups] defining septic shock Message-ID: <fb007ec8479628499f04b6c30791061322053...@fwdcwpmsghcmd3d.hca.corpad.net> Content-Type: text/plain; charset="iso-8859-1" If septic shock is defined by the SSG as "sepsis-induced hypotension persisting after adequate fluid resuscitation" wouldn't it be correct to say that an initial lactate *4 is still severe sepsis but a lactate *4 AFTER fluid resuscitation is sepsis induced "persistent" hypoperfusion? And, only then it shall be referred to as septic shock? I'm having a difficult time with the assumption that an initial lactate of *4 with a normal blood pressure and a patient who is alert and oriented x4 is being diagnosed with shock. I do agree that the initial lactate may qualify the patient for the need for fluid resuscitation (if it is sepsis-induced), but not necessarily a diagnosis of shock at this point. Amber Parman RN, BSN, CCRN Denton Regional Medical Center Sepsis Coordinator 940-384-4363 [email protected] [cid:[email protected]] [cid:[email protected]] Enhancing community health through service with compassion, excellence and efficiency. This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing, or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email or contact the sender at the number listed. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160209/8df8107f/attachment-0001.htm> -------------- next part -------------- A non-text attachment was scrubbed... Name: image001.png Type: image/png Size: 11972 bytes Desc: image001.png URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160209/8df8107f/attachment-0001.png> -------------- next part -------------- A non-text attachment was scrubbed... Name: image002.jpg Type: image/jpeg Size: 1473 bytes Desc: image002.jpg URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160209/8df8107f/attachment-0001.jpg> ------------------------------ Message: 2 Date: Tue, 9 Feb 2016 15:09:09 +0000 From: <[email protected]> To: <[email protected]> Subject: [Sepsis Groups] Septic shock presentation Message-ID: <fb007ec8479628499f04b6c30791061322053...@fwdcwpmsghcmd3d.hca.corpad.net> Content-Type: text/plain; charset="us-ascii" If a patient with severe sepsis and hypotension receives a 30ml/kg fluid bolus and is started on vasopressors within the hour of completion of the fluid bolus, is it "assumed" that persistent hypotension is present or do you actually need documentation of 2 hypotensive blood pressures to say "yes" to persistent hypotension present? Amber Parman RN, BSN, CCRN Denton Regional Medical Center Sepsis Coordinator 940-384-4363 [email protected] [cid:[email protected]] [cid:[email protected]] Enhancing community health through service with compassion, excellence and efficiency. This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing, or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email or contact the sender at the number listed. -------------- next part -------------- An HTML attachment was scrubbed... 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