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

2253 Words Dec 15th, 2013 10 Pages
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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Crystalloids should be the first initial fluid choice during resuscitation. If the patient remains hypotensive, vasopressor therapy should be initiated using norepinephrine as the first choice (Dellinger et al., 2013).
Antimicrobial Therapy in the ED. The administration of broad-spectrum antimicrobials with the first hour of recognition of sepsis is vital to patient mortality. In multiple studies, each hour of delay in antibiotic administration is associated with a measurable increase in patient mortality (Dellinger et al., 2013). Another vital component of treatment is the choice of empirical antimicrobial therapy. Kumar et al., found that survival rates after appropriate and inappropriate initial therapy were 52.0% and 10.3% respectively (Kumar et al., 2009). This is a huge disparity for patients and therefore a large focus for EDs.
Barriers to Care and Suggestions for Improvement
Suboptimal treatment of sepsis is widespread. “Compliance with the 6 hour resuscitation pundle is poor, ranging from 19% to 52%” (Aitken et al., 2011). For example, even though the Surviving Sepsis Campaign (SSC) has distributed guidelines, reflecting the Early Goal Directed Therapy (EGDT) studied by Rivers and colleagues, suggesting the administration of antibiotics within 1 hour of suspected bacterial infection, the average time for the first infusion of antibiotics exceeds 3 hours. Other suboptimal

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