Sepsis in the Emergency Department: Improvements in Rapid Assessment and Treatment

The aim of the essay is to analyse the care of a septic patient. While discussing the relevant physiological changes and the rationale for the treatment the patient received, concentrating on fluid intervention. I recognise there are other elements to the Surviving Sepsis Bundles, however due to word limitation; the focus will be on fluid intervention. The essay will be written as a Case Study format.

Management of the acutely ill adult is a complex and perplexed procedure. It requires underpinning knowledge of the pathophysiology of the disease currently affecting the patient, as well as ensuring that professionals are equipped to deal with the development of a rapid deterioration. The National Institute for Clinical Excellence (2007) explain that patients are sometimes inadequately treated due to staff not acting in a sufficient time manner, and so a systematic assessment of the patient recommended by the Resuscitation Council (2006) should initially be followed (Jevon, 2009).

As I reflect on the evaluations of my presentations, I had the opportunity to request how well the information I presented informed my fellow nurses and managers. I am content with my research and prepared work. I feel I was able to design a renewed importance to the sepsis diagnosis and how we can create more effective teaching tools. On my evaluations, I was able to request the attendees to review my teaching and presentation abilities, use current standards and utilize reputable peer- reviewed articles as a form of a reference, and develop a comprehensible early recognition strategies of sepsis for nurses and case managers. After handing out my evaluations to my attendees and presenting my sepsis presentation I asked the attendees to rate

The aim of this assignment is to critically discuss the nursing assessment individualised care and nursing interventions of the acutely ill patient. The patient discussed developed severe sepsis due to a urinary tract infection and her condition deteriorated during the recovery process in the nurse’s care. Lovick (2009) defines sepsis ‘as a known or suspected infection accompanied by evidence of two or more of the SIRS criteria’. SIRS is outlined as a ‘systemic inflammatory response’ consisting of two or more of the following symptoms ‘temperature >38 degrees Celsius or 90 beats per minute, respiratory rates greater than 20 breaths per minute and white blood count higher than 12,000 cells per microliter or lower than 4000 cells per

Septic shock is the leading cause of death for patients in intensive care units and is the final stage in a continuum of infectious and inflammatory processes. This continuum begins with bacteremia, which is the presence of bacteria in the blood. Normally the body’s immune system can fight off a localized infection caused by a small amount of bacteria in the blood and the person will remain asymptomatic. However, a hospitalized patient could be immunocompromised, have a

Is sepsis complicated by organ dysfunction, is diagnosed in more than 750,000 patients per year and has mortality rates as high as 28%-50%.

The number of documented cases has been rising every year. “This may be due to the aging population, the increased longevity of people with chronic disease, the spread of antibiotic-resistant organisms, an upsurge in invasive procedures and broader use of immunosuppressive and chemotherapeutic agents” (National Institute of General Medical Sciences, 2014). The mortality rate for sepsis ranges from about thirty percent for patients with sepsis to fifty percent in patients who develop septic shock. Mortality rate varies as to how many organs have been affected. Twenty percent mortality for one organ failure, forty percent for two organs failing, sixty-five to seventy percent for three failed organs, and seventy-five to eighty-five percent when four or more organs have failed. The cost related to sepsis is about seventeen billion dollars per year (about twenty-two thousand dollars per patient), which is six times greater than the cost of patients without sepsis.

There is a disease continuum with increasing severity if not treated or not responsive to treatment o Sepsis

Under the Core measures, Sepsis is one of the problem-focused trigger for systemic infection and if untreated which can lead to death. In United States, it is the 11th leading cause of death and consumes the large amount of costs about $20.3 billion in 2011 (Jones et al.,2016). According to Centers for Disease Control and Prevention (CDC), more than 1.5 million people diagnosed with sepsis, and at least 250,000 patients die from that yearly (CDC, 2017). The evidence-based research revealed with results of certain pre existing conditions, pathophysiological studies, preventive measures and sepsis bundle for treating and preventing sepsis to save the life of the patients.

Sepsis is a severe complication of an inflammatory response due to various pathogens with the mortality rates ranging anywhere between twenty-five to thirty percent (Epstein, Dantes, Magill, & Fiore, 2016). Sepsis can be precipitated by various infections including some of the most common ones, like urinary tract infections, pneumonia, and cellulitis. An early sepsis recognition is crucial in improving patient outcomes and decreasing mortality rate. Thus, it is very important for a health care provider to start the necessary diagnostics and implementation of fluids, antibiotics, vasopressors and other necessary treatments based on the

et al., 2008). Sepsis is a frequent cause of admission to intensive care units (ICUs) and it

I believe it’s important to the Science of Nursing because early recognition will prevent organ dysfunction which can lead to death. In some cases, the SSC recommended Early Goal Directed Therapy (EGDT) based on patient presentation, vital sign and lab studies. The EGDT bundles consist of early Intravenous Fluid (IV) resuscitation and IV broad spectrum antibiotics should be given within three hours of serum lactate. According to the Center for Disease Control (CDC), it’s documented from 1999-2014, a total of 2,470,666 deaths were associated with sepsis (CDC, 2016). After reading the CDC fact sheet, my conclusion is that most of the sepsis cases that the EGDT bundle was not initiated on time (six hour compliance) due to early recognition of signs and symptoms presented upon arrival and the lack of communication between team members which delayed EGDT greater than six hour window. From the studies that I have read, the Surviving Sepsis Campaign

This includes debate about the best potential biomarkers, ways to assess volume status of patients, and the most efficient way to diagnose patients with sepsis, all of which are critical to improving mortality. The hypothesis that monitoring fluid status of patients with sepsis and septic shock via ultrasound and less aggressive fluid resuscitation will lead to improved patient mortality will be

Therefore, the skills obtained from education will assist the nurses to monitor and detect if the patient is suffering from sepsis. From that observation, the nurse can decide to initiate the established sepsis protocol. Educational intervention will provide nurses with skills that can help them to detect sepsis through clinical signs and laboratory values. Once this evaluation has been done, nurses will use their knowledge to administer appropriate therapy in the early stages of sepsis, and it greatly influences the patient

Sepsis is a debilitating, potentially life threatening condition that has become a big burden on the health system worldwide. Early recognition and aggressive timely treatment have proven to be life saving interventions. South Miami Hospital (SMH) aims to provide safe care to our community by implementing and utilizing evidence –based guidelines and protocols. According to research, early identification of patients presenting with signs and symptoms of sepsis is crucial to patients’ survival. In order to achieve this goal SMH Emergency Department (ED) implemented a triage sepsis-screening tool, an intervention that as evidenced by research helps to recognize patients at risk for developing sepsis or presenting with this devastating disease.