Emergency management of sepsis: The simple stuff saves lives

David Sweet , Julian Marsden , Kendall Ho , Christina Krause , James A Russell
British Columbia Medical Journal 2012, 54 (4): 176-182
Many emergency departments have implemented sepsis protocols since the 2001 publication of results from the early goal-directed therapy trial, which showed early targeted resuscitation lowers mortality. As part of an attempt to improve clinical and operational outcomes for emergency departments across British Columbia, we reviewed sepsis management literature and considered sepsis protocol implementation in the province’s emergency departments. During the literature review we found that many observational studies confirmed an association between implementation of emergency sepsis protocols and decreased mortality. The literature also confirmed that septic patients who have elevated serum lactate and do not clear serum lactate rapidly have increased mortality, and that delay in administration of antibiotics after onset of septic shock was associated with increased mortality. Two BC-based initiatives, the Evidence to Excellence Sepsis Collaborative and Clinical Care Management, support improvements in management of sepsis in BC emergency departments, which should include early identification of septic patients, rapid and appropriate fluid resuscitation, lab tests (serum lactate and blood cultures), antibiotic administration, and source control of infection. Close clinical monitoring and biomarker (lactate) monitoring are also necessary during resuscitation to optimize safety and efficacy.

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