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

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Sepsis remains one of the most deadly diseases in the country. According to the literature, a majority of sepsis cases filter though the Emergency department. The diagnosis and treatment of sepsis are complex and the barriers to improving these things are even more intricate but the fact remains that improvement of sepsis care begins in the ED. Early recognition of sepsis using the SIRS criteria followed by multidisciplinary rapid response diagnostic testing and treatment are the keys to improvement of sepsis care in the ED.

Sepsis is defined by the Surviving Sepsis Campaign (SSC) as “the presence (probable or documented) of infection together with systemic manifestations of infection” (Dellinger et al.,
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8. Hyperbilirubinemia (plasma total bilirubin level > 4 mg/dL)
9. Hyperlactatemia (> upper limit of normal)
(Simpson & Pitts, 2010)

Management of Severe Sepsis:
More than 500,000 cases of severe sepsis are initially managed in the US emergency departments annually, with an average ED length of stay of 5 hours. The cornerstones of management of severe sepsis includes prompt diagnosis, timely administration of appropriate antibiotics, and aggressive resuscitation.
Recognition of Sepsis in the ED. It is well known within health care professionals as well as the general public that, in the first hours of a myocardial infarction or cerebral vascular accident, time is tissue. This is also the case in severe sepsis and because of this, early recognition of sepsis is vital to improving outcomes. SIRS is the first line diagnostic for the recognition of sepsis. If the patient meets SIRS criteria, the next line of diagnostics is to test the serum lactate. Lactate is believed to be due to decreased end-organ perfusion, leading to anaerobic glycolysis and lactate production. Serum lactate is commonly used as a prognostic test for illness severity in ED patients with sepsis (Green et al., 2011).
Resuscitation in the ED. Rapid Quantitative resuscitation is recommended in all patients with tissue hypoperfusion. According to the SSC guidelines, the goals of fluid resuscitation include a CVP of 8-12 mm Hg, a MAP > 65 mm Hg, urine

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