I think you may be recalling when arterial blood is used versus venous. You can use either but the reminder was to know the range will be different depending on which you are using.
Donna Darlington BSN, RN Quality Improvement Coordinator Ph: 269-789-7011 [email protected] >>> <[email protected]> 2/15/2016 10:22 AM >>> 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: Repeat lactate (Belfi, Karen) 2. Re: Shock for dialysis patients (Belfi, Karen) 3. Re: Defining septic shock (Gerard, Daniel) ---------------------------------------------------------------------- Message: 1 Date: Fri, 12 Feb 2016 06:50:20 -0500 From: "Belfi, Karen" <[email protected]> To: Shelly Guyer <[email protected]> Cc: "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Repeat lactate Message-ID: <[email protected]> Content-Type: text/plain; charset="utf-8" I don't remember anything stating same route. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center On Feb 11, 2016, at 5:07 PM, Shelly Guyer <[email protected]<mailto:[email protected]>> wrote: Does anyone remember seeing that a repeat lactate must be drawn using the same route as the initial lactate? I know I saw this somewhere, but now I can?t find it. The spec manual does not say it must be the same route. Would appreciate any comments. Thank You Shelly Guyer RN, MSN Performance Improvement 691-5497 ________________________________ Confidentiality Notice: This email message, including any attachments, is for the sole use of the intended recipient(s), and may contain privileged or confidential information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please notify the sender of this email, and destroy all copies of the original message. _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ Message: 2 Date: Fri, 12 Feb 2016 07:23:02 -0500 From: "Belfi, Karen" <[email protected]> To: Rona Capps <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Shock for dialysis patients Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" The entire amount must be ordered and infused. CMS has said that physicians need to use their clinical judgment, and 100% is not expected. At this time, they do not have any contraindications to the crystalloid fluid built into the guidelines. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center 484-476-8092 Pager: 5240 -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Rona Capps Sent: Monday, February 08, 2016 10:58 AM To: [email protected] Subject: [Sepsis Groups] Shock for dialysis patients Can someone please tell me the proper answer to a physician. A dialysis patient comes in with Septic Shock. A. If he orders the amount of fluid required but never starts it, will it pass? B. If he orders the correct amount and only administers 500ml of the total, will it pass? What is the work around for this part of the measure that is not taking into account physician clinical judgment? Thank you Rona Capps, RN Sepsis Coordinator Jackson Hospital Montgomery, AL 36106 [email protected] -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Friday, February 05, 2016 2:08 PM To: [email protected] Subject: Sepsisgroups Digest, Vol 190, Issue 5 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: Septic Shock Presentation Time (DHILLON, ROOPINDER) 2. Septic Shock presentation (DHILLON, ROOPINDER) ---------------------------------------------------------------------- Message: 1 Date: Tue, 2 Feb 2016 13:19:56 +0000 From: "DHILLON, ROOPINDER" <[email protected]> To: "'Miller, Nicole'" <[email protected]>, "Belfi, Karen" <[email protected]>, "[email protected]" <[email protected]>, "[email protected]" <[email protected]>, "[email protected]" <[email protected]> Cc: "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Septic Shock Presentation Time Message-ID: <[email protected]> Content-Type: text/plain; charset="utf-8" Hi Nicole, In answer to your following question regarding the Septic shock time, it will be 0751, in other words the Septic Shock time will be same as Severe Sepsis time. Thank you. -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Miller, Nicole Sent: Monday, February 01, 2016 12:16 PM To: Belfi, Karen; [email protected]; [email protected]; [email protected] Cc: [email protected] Subject: Re: [Sepsis Groups] Septic Shock Presentation Time Can I get some assistance on this presentation time for Severe Sepsis/Shock? Source of infection at 07:51 Two SIRS at 07:25 and 07:40 Organ dysfunction at 07:12 Severe Sepsis time=07:51---however, the organ dysfunction is a lactate of 5.1. Do I take the Septic Shock time as 07:51 since I can't say I have Septic Shock without a source of infection? Thank you! Nicole Miller, BSN, RN, CPHQ | PI Coordinator Edward-Elmhurst Healthcare | 801 South Washington, Naperville, IL 60540 (630) 527-5565 | HealthyDriven.com This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this information is STRICTLY PROHIBITED. If you have received this message in error, please notify us immediately and destroy the related message. CONFIDENTIALITY NOTICE: E-EH System Patient Safety Work Product (PSWP). For use by authorized individuals only. DO NOT COPY or DO NOT DISSEMINATE. -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Belfi, Karen Sent: Friday, January 29, 2016 5:16 AM To: [email protected]; [email protected]; [email protected] Cc: [email protected] Subject: Re: [Sepsis Groups] Septic Shock Presentation Time This is contradictory to everything they stated in both the power point and the Q&A. >From the Q&A: Question 61: If lactate is >4 and no crystalloid fluids are administered, do you answer ?Yes? or ?No? for Septic Shock present? Answer 61: The Septic Shock Present data element's Notes for Abstraction indicates that if crystalloid fluids were not administered after the presentation date and time of severe sepsis, to choose Value "2 (No)." Question 145: If initial lactate is >4, but no crystalloid fluids are given during the 6 hours after severe sepsis, do we answer "No" to septic shock? Answer 145: Not necessarily. You would select "No" for Septic Shock Present if no crystalloid fluids were given at all after presentation of severe sepsis. There is no time frame after severe sepsis presentation associated with this. If fluids were not given within 6 hours following presentation of severe sepsis but were given after 6 hours, then you would select "Yes." This is an all-or-none point for crystalloid fluids. Question 172: If the patient has severe sepsis and an initial lactate of 4.5 but does not receive any crystalloid fluids, would it still be "No" to Septic Shock Present due to not having any crystalloids given? Answer 172: Correct. This was from the transcript of the CMS presentation on October 26 (page 27): Now please note, in the septic shock present data element, there is a bullet point in the note for abstraction indicating that if crystalloid fluids were not administered after severe sepsis presentation date and time, that you would select allowable value 2 for septic shock present, which is equivalent to No. For purposes of SEP-1 measure, at this point in time, regardless of how septic shock is identified, if no crystalloid fluids were given after severe sepsis presentation, you will select allowable value 2, which is No, for septic shock present. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center 484-476-8092 Pager: 5240 -----Original Message----- From: [email protected] [mailto:[email protected]] Sent: Thursday, January 28, 2016 4:04 PM To: [email protected]; [email protected]; Belfi, Karen Cc: [email protected] Subject: RE: [Sepsis Groups] Septic Shock Presentation Time I sent the question regarding fluids and septic shock presentation to CMS and this is the response I received in November: Gena, There are three ways to determine if Septic Shock is present. 1. Severe Sepsis present AND Hypotension persists in the hour after crystalloid fluid administration 2. Severe Sepsis present AND Initial Lactate level >= 4mmol/L 3. Physician documentation of septic shock For #2 - Crystalloid fluid administration is not required to determine whether the patient has septic shock if using the presence of severe sepsis and the lactate level to determine. Thanks, Gena Henriques, MSN, RN Quality Review Coordinator - Sepsis Tulane Medical Center 1415 Tulane Ave. New Orleans, LA 70112 Phone: 504-988-3195 Think Sepsis: Save A Life 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. -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Cobb, Amy L. Sent: Thursday, January 28, 2016 5:45 AM To: Townsend, Sean, M.D.; Belfi, Karen Cc: [email protected] Subject: [EXTERNAL] Re: [Sepsis Groups] Septic Shock Presentation Time Has something changed in the Spec Manual since the v5.0b came out? This is copied and pasted from the manual: *If criteria for Septic Shock are not met, but there is physician/APN/PA documentation of Septic Shock, choose Value ?1.? Allowable Values: 1 (Yes) There is documentation of Septic Shock 2 (No) There is no documentation of Septic Shock, or unable to determine Dr. Townsend, can you clarify this if physician documentation is not enough and let us know if this was changed/updated? Thank you Amy Cobb RN, BSN Sepsis Coordinator Research Outcomes Morton Plant Hospital MS #73 300 Pinellas St. Clearwater, FL 33756 727-298-6953 (Desk) 727-462-3638 (Fax) [email protected] -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Townsend, Sean, M.D. Sent: Monday, January 25, 2016 4:12 PM To: Belfi, Karen Cc: [email protected] Subject: Re: [Sepsis Groups] Septic Shock Presentation Time I don't see criteria met at 10:47. MD say so is not enough. On Jan 25, 2016, at 1:02 PM, Belfi, Karen <[email protected]<mailto:[email protected]>> wrote: 10:47 would be septic shock time. It?s the earliest time criteria is met. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center 484-476-8092 Pager: 5240 <image001.png> From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected]<mailto:[email protected]> Sent: Wednesday, January 20, 2016 9:15 PM To: [email protected]<mailto:[email protected]> Subject: [Sepsis Groups] Septic Shock Presentation Time Clinical criteria for severe sepsis is met at 1002. Crystalloid bolus completed at 1247. SBP=79 @ 1300. SBP=87 @1330. Initial lactic acid =4.0 resulted at 1126. ED physician note started at 1047 containing documentation of possible septic shock. Would septic shock presentation time be 1047, 1126 or 1300? Karen King, RN MSN Quality Management Core Measures Specialist, Lead Lakeview Regional Medical Center 95 Judge Tanner Boulevard Covington, LA 70433 Office: (985) 867-4467 Cell: (985) 788-0585 Fax: (985) 867-4263 Email: [email protected]<mailto:[email protected]> 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. _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=CwIGaQ&c=MS-5dKql6qjhmD6zBX8NdQ&r=KQhQAyB28wX0ryHeUUrvHwtJt_LBhCc_ENWLFE_5OQM&m=MIOxJC-J0Hl7V8zraHmRvAJqUnUQxV84ioAAkoOtpPQ&s=PE9haHZiSt0lsaWrtXo79byWSukDpnw1Pcj-cZckiGI&e= _______________________________________________ Sepsisgroups mailing list [email protected] https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=CwIGaQ&c=MS-5dKql6qjhmD6zBX8NdQ&r=KQhQAyB28wX0ryHeUUrvHwtJt_LBhCc_ENWLFE_5OQM&m=MIOxJC-J0Hl7V8zraHmRvAJqUnUQxV84ioAAkoOtpPQ&s=PE9haHZiSt0lsaWrtXo79byWSukDpnw1Pcj-cZckiGI&e= ---------------------------------------------------------------------- Confidential: This electronic message and all contents contain information from BayCare Health System which may be privileged, confidential or otherwise protected from disclosure. The information is intended to be for the addressee only. If you are not the addressee, any disclosure, copy, distribution or use of the contents of this message is prohibited. If you have received this electronic message in error, please notify the sender and destroy the original message and all copies. _______________________________________________ Sepsisgroups mailing list [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 _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org Visit us at www.UHhospitals.org. The enclosed information is STRICTLY CONFIDENTIAL and is intended for the use of the addressee only. University Hospitals and its affiliates disclaim any responsibility for unauthorized disclosure of this information to anyone other than the addressee. Federal and Ohio law protect patient medical information, including psychiatric_disorders, (H.I.V) test results, A.I.Ds-related conditions, alcohol, and/or drug_dependence or abuse disclosed in this email. Federal regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and 3701.243 prohibit disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law. ------------------------------ Message: 2 Date: Tue, 2 Feb 2016 15:04:00 +0000 From: "DHILLON, ROOPINDER" <[email protected]> To: "[email protected]" <[email protected]> Subject: [Sepsis Groups] Septic Shock presentation Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" Please see the following scenario... The Patient had severe sepsis based on the following... Source of infection, SIRs and Organ dysfunction (Hypotensive with Systolic 75). No initial lactate was done and the Crystalloid fluid administered was <30 ml/kg. What should I answer for the question Septic shock present, considering the patient was hypotensive even after conclusion of the fluid amount (rate was also <125 ml/hr). Thank you, Roopa Dhillon MBBS, MBA Clinical Quality Analyst I Quality Improvement/Clinical Outcomes University Hospitals Elyria Medical Centre 630 East River Elyria, Ohio 44035 T 440-329-4959 F 440-329-5971 Roopinder.Dhillon@UHhospitals<mailto:Roopinder.Dhillon@UHhospitals> .org Quality Assurance/Peer Review Privileged Pursuant to Ohio Rev. Code secs. 2305.24, 2305.25, 2305.251, 2305.252 and 2305.253 Visit us at www.UHhospitals.org. The enclosed information is STRICTLY CONFIDENTIAL and is intended for the use of the addressee only. University Hospitals and its affiliates disclaim any responsibility for unauthorized disclosure of this information to anyone other than the addressee. Federal and Ohio law protect patient medical information, including psychiatric_disorders, (H.I.V) test results, A.I.Ds-related conditions, alcohol, and/or drug_dependence or abuse disclosed in this email. Federal regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and 3701.243 prohibit disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160202/5d39ba26/attachment.html> ------------------------------ Subject: Digest Footer _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ End of Sepsisgroups Digest, Vol 190, Issue 5 ******************************************** _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ Message: 3 Date: Fri, 12 Feb 2016 14:20:58 +0000 From: "Gerard, Daniel" <[email protected]> To: "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Defining septic shock Message-ID: <blupr08mb1682cbb5c0a95e26df6bf0e6c7...@blupr08mb1682.namprd08.prod.outlook.com> Content-Type: text/plain; charset="iso-8859-1" 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... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160209/2187a30c/attachment.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/20160209/2187a30c/attachment.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/20160209/2187a30c/attachment.jpg> ------------------------------ Subject: Digest Footer _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ End of Sepsisgroups Digest, Vol 191, Issue 1 ******************************************** CONFIDENTIALITY NOTICE: This email message and any attachments are intended solely for the intended recipient(s), may contain confidential and/or privileged information and may be legally protected from disclosure. If you are not the intended recipient of this message, or if this message has been addressed to you in error, immediately alert the sender by reply email and delete this message and any attachments. If you are not the intended recipient, you are hereby notified that any use, dissemination, copying, or storage of this message or its attachments is strictly prohibited. ------------------------------ Subject: Digest Footer _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ End of Sepsisgroups Digest, Vol 192, Issue 1 ******************************************** --------------------------------------------------------------------------------------- This email has been scanned for email related threats and delivered safely by Mimecast. For more information please visit http://www.mimecast.com ---------------------------------------------------------------------------------------
_______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
