Septic Shock

Sepsis is both best known yet most poorly understood medical disorders [1]. Sepsis leads to shock, multiple organ failure and death if not recognized early and treated promptly [2]. It is a serious clinical condition that represents a patient’s response to infection and has a high mortality rate [3]. Sepsis remains the dominant challenge in the care of critically ill patients [4]. Up to 19 million cases of sepsis worldwide per annum is estimated. The true incidence is higher [1]. Sepsis is associated with a mortality rate of 25 - 30% and mortality due to septic shock is 50-85% [6-8]. Patients with sepsis requiring intensive care unit (ICU) admission had high rates of ICU and overall hospital mortality, ranging from 18 to 50% [9-12]. The most common sites of infection are

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).

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).

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.

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).

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

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

With total U S hospitals costs of over $20 billion, sepsis is one of the most expensive health conditions treated in hospitals (1). According to the Centers for Disease Control and Prevention (CDC), sepsis affects more than 1.5 million people each year, proving fatal for approximately 250,000 of those individuals (2). The CDC estimates that one out of every three patient deaths in a hospital involves sepsis (2). While the incidence of sepsis is reportedly increasing (3, 4), it is difficult to obtain an accurate figure.

A methodical search was undertaken of the databases – PubMed, CINAHL and ScienceDirect to ascertain the most appropriate evidence. Search terms used were “Sepsis Prevention”, “Sepsis Management” “Sepsis Early Recognition” and “Sepsis Detection” and merged using Boolean Logic (Glasper and Rees,

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.

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

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.