Early interventions in ED stop rapid deterioration
Identifying septic patients at triage can decrease the potential for development of organ dysfunction leading to severe sepsis and septic shock, says Christa Schorr, RN, BSN, the program manager responsible for data collection and analysis of the Surviving Sepsis Campaign database at Cooper University Hospital in Camden, NJ.
"Starting an early goal-directed protocol in the ED can often ward off the potential need for more aggressive therapies," adds Schorr. Rapid reversal of tissue hypoperfusion can help prevent worsening cardiovascular status and can avoid other vital organs from failing, she explains.
Here is an example to show how a septic patient's outcome could be affected with the ED's protocol: Smith, a female, presents to the ED with a suspected infection at her port-a-cath site. On presentation, her temperature was 101.4, heart rate 106, respiratory rate 22, blood pressure 85/42, and lactate 5.2 mmol/L. Her family claims she has been confused throughout the day. Based on this presentation, Smith qualifies for the protocol.
After Smith's mental status continues to decline, supplemental oxygen is added. The nurse identifies an elevated creatinine and decreased urine output. A central line is placed, and fluid resuscitation is initiated. After receiving 20ml/kg of normal saline, the systolic blood pressure remains in the 80s. A norepinephrine infusion is started.
Three hours into the treatment, the ED nurse finds that Smith's blood pressure and urine output are increasing. Smith is transferred to the intensive care unit (ICU) at hour four. Target goals for central venous pressure and central venous oxygen saturation are met five hours after treatment was started. Norepinephrine is weaned off by hour six. Smith is monitored in the ICU, is able to maintain a blood pressure of 110/60 throughout the night, and is able to converse normally. She is transferred to a general care floor within 24 hours.
Early recognition and initiation of treatment contributes to the rapid reversal of organ dysfunction, says Schorr. "If gone unnoticed or untreated, her condition may have rapidly deteriorated, requiring additional therapies such as a continuous and/or multiple vasopressor infusions, renal replacement therapy, and perhaps mechanical ventilation," she says.
Identifying septic patients at triage can decrease the potential for development of organ dysfunction leading to severe sepsis and septic shock, says Christa Schorr, RN, BSN, the program manager responsible for data collection and analysis of the Surviving Sepsis Campaign database at Cooper University Hospital in Camden, NJ.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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