Septic Shock

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

Early identification of sepsis is crucial when caring for patients at risk for sepsis. The

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).

Utilizing the five points mentioned would transition the information from the systematic review into practice. The review would identify as an evidence summary in the model, producing a more manageable quantity of information. It can then be translated as it is combined with clinical expertise and tailored to the clinical setting. The setting that would benefit the most from this change would be those in the critical care setting, as septic patients are in a critical state and are monitored closely. Having strong supporting evidence will make a substantial argument to change practices. Utilizing the data, combined with clinical expertise and experience, supports the changes needed to provide the most up to date, evidence based care. Clinical expertise regarding sepsis benefits the healthcare team in acknowledging other clinical data that could be used to determine fluid volume status, straying away from depending on central venous pressure. The goal would be to transition from using central venous pressure as a reliable indicator of fluid volume status to utilizing noninvasive cardiac output monitoring, when possible, and other clinical indicators. Another change would involve discrediting the validity of central venous pressure as a volume status indicator to clinicians. Mark, Monnet, and Teboul (2007) noted that 90% of intensivists use central venous pressure

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

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.

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).

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).

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.

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

The early sepsis protocol has a huge impact on Emergency Department (ED) patients that are suspected of sepsis. The studies have shown that early recognition has a significant effect on the patient’s outcome. My paper will only analyze data collected in the critical care settings and focus mainly on the importance of early recognition of the signs and symptoms of sepsis to meet the three hour window treatment as recommended by the Surviving Sepsis Campaign (SSC).

Sepsis and the lasting physiological effects of survivors are major concerns for the Center for Medicare/Medicaid Services (CMS),

The exact definitions, stratification, and approach to diagnosis of the sepsis spectrum has been a persistent, yet seemingly productive, endeavor for many years1,5,16. Multiple consortiums have addressed the approach to diagnosing sepsis. In 1992, a consortium, comprised of the American College of Chest Physicians and the Society of Critical Care Medicine, instituted the Systemic Inflammatory Response Syndrome (SIRS) criteria which established the fundamental screening tool for identifying individuals with an inflammatory immune response (Table 1)5. A patient exhibiting two or more of the SIRS criteria combined with the presence or suspicion of infection was the fundamental criteria for sepsis diagnosis5. Although this approach is of merit, it is too broad. Patients recovering from surgery or suffering from various non-infectious processes would meet the criteria for sepsis under SIRS17,18. An exhaustive list of exogenous and endogenous processes may generate a SIRS-inclusive response in the absence of infection18. A criteria with greater specificity was greatly needed.

Sepsis is a phenomenon in which an infective agent results in a physiological response in excess of the pathogenic insult. Efforts to define and investigate sepsis have been somewhat fruitful in elucidating the nuances of this phenomenon. Yet, gaps exist in identifying and investigating sepsis. Recent efforts have streamlined the definition and identification criteria of sepsis and septic shock. The treatment of sepsis is based on the elements of identification, hemodynamic interventions (fluid and vasopressor resuscitation), and antimicrobial therapy/source control. A two-tiered approach employing the qSOFA (Quick Sepsis-Related Organ Failure Assessment) and SOFA (Sepsis-Related Organ Failure Assessment) tools now provide a succinct criteria for sepsis and septic shock. Various approaches may be taken to assess fluid responsiveness, provide fluid resuscitation, and determine the need for vasopressor support. Early, aggressive antimicrobial therapy is essential to the treatment of sepsis. Obtaining source control and considering early surgical

The results showed that the use of SUP in patients with severe sepsis did not have a significantly decreased risk of GI bleeding or an increased risk of CDI. However, the use of SUP in critically ill patients had an increased risk of HAP. As a result, SUP might be unnecessary for patients with severe sepsis. Although there is extensive research concerning the effectiveness of pharmacologic agents of SUP, this study illustrates that prophylactic SUP may lead to adverse outcomes. Nurses can benefit from this practice because it can help prevent complications like HAP when treating patients with severe sepsis.