Septic Shock

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.

This study was conducted within a six-hospital system, with a total of 856 acute care beds with the main unit a 650-bed level two trauma center. A team was put together from many areas of the hospital: education, urology, hospitalist, and infection control to oversee assessment, interventions, implementation and outcome of the study. Applicable edification was provided for the health-care providers and the protocols, policy and procedures that would have been executed were revised. Multiplicities of pre-cautionary measures were initiated; health-care workers took care

Unlike Hester’s sin of adultery, which she redeemed through charitable and amicable behavior, Chillingworth’s misdeed is one of malice and remains largely unredeemed at the end of The Scarlet Letter. At the beginning of the novel, Chillingworth makes a point of befriending Dimmesdale only so that he may gradually siphon away the minister’s liveliness and vigor, a phenomenon that Hawthorne alludes to by comparing Chillingworth to a blood-sucking leech. As his hatred develops further, Chillingworth “[grows] emaciated, his voice… [becoming] a certain melancholy prophecy of decay” (9). This consequence of Chillingworth’s spite, which haunts him physically so that he becomes a gaunter, more harrowed and wretched version of himself, becomes increasingly

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.

According to the National Institute of General Medical Sciences severe sepsis strikes about 750,000 people in the United States each year and kills an estimated 28 to 50 percent of those individuals. The most vulnerable populations for sepsis are the elderly and newborns. After completing the whole eleven segments, I learned that anyone with an infection may be at risk for developing sepsis. The whole scenario helped me how to screen for sepsis and how important is to recognize and respond appropriately to early signs of sepsis in hospitalized patients. Once sepsis is diagnosed, early and aggressive treatment can begin which greatly reduces mortality rates associated with sepsis. After completing the whole scenario I learned how to approach

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.

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

I- Implementing an ER sepsis protocol on all individuals that meet sepsis criteria immediately on arrival to ER (i.e. start multiple intravenous antibiotics,

An aspect where fluid resuscitation can be beneficial to the outcome of the patient is when sepsis is present. According to Bozza et al (2010), “hemodynamic instability plays a major role in the pathogenesis of systemic inflammation, tissue hypoxia, and multiple organ dysfunction in sepsis,” and that fluid therapy reduces mortality in these patients by helping to restore this imbalance. Thus establishing that fluid resuscitation can be beneficial in prehospital care as it assists in maintaining adequate organ and tissue perfusion. This evidence is also supported by Daniels (2011), who outlines that early diagnosis and early fluid therapy is associated with decreased mortality in sepsis patients, as maintaining a systolic blood pressure

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

The set of diagnostic procedures and the necessary treatment within this bundle is based on the EBP suggested guidelines. By following the recommended guidelines, I can assure the improvement of quality of care by providing my patient with the best current practice. According to the randomized study over a 12-month period conducted in the Emergency Departments (ED) in New Wales, Australia the introduction of sepsis guidelines in ED improved the early assessment and management of septic patients including reduction in time to antibiotic administration by 230 minutes and the improved urgent triage time by 49.1 % (Romero, Fry, & Roche, 2017).

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 with every industry and business, there is competition. In the case of the craft beer industry, the competition is medium and growing. From challenging the big macro-breweries, to battling against new incoming brewery businesses, the craft beer industry is absolutely on the radar for competition. Macro-breweries are still the largest competitors with craft breweries. The major player in the craft beer industry, according to IBISWorld, is The Boston Beer Company. It holds a market share in the overall beer industry of only 2.7%, and a revenue of $885.5 million in 2014. In comparison to the major players in the overall beer industry, Anheuser-Busch InBev and MillerCoors

Lifestyle of peasants in medieval Europe was tremendously challenging. Seeing that, they were at the bottom of the European feudal system that foresaw peasants as the main working force. During the Middle Ages the concrete structure of the society classified individuals from the moment they were born. Which resulted in, no significant changes attributed to the work one was able to endure. Meanwhile; homes, clothing, food and marriage were the prominent contributors that determined your status/class. For means of survival peasants worked extremely long hours each day to obtain the basic necessities of; food, shelter and clothing. Most peasants were farmers however, a select few were Tradesmen who work as Miller's or in the tavern establishment. Peasants obeyed their local Lord swearing an “oath of obedience” on the Bible. This ensured to peasants loyalty and commitment to a Lord, in aspirations of producing goods and other fineries.

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.