Introduction
Sepsis is responsible for about a one third of RRT alerts (approximately 1/3 respirator insufficiency, 1/3 hypovolemia) and significant morbidity and mortality. Early recognition of subtle physiologic abnormalities and prompt basic treatment can dramatically improve outcomes.
In septic shock, early support of the respiratory system with noninvasive or invasive ventilation allows blood to be redirected to the abdomen from diaphragms and intercostal muscles, reducing organ ischemic.
Overview
The early recognition and treatment of sepsis is paramount in improving outcomes of these patients. However, unlike trauma, stroke or acute myocardial infarction, the initial signs of sepsis are subtle and easily missed by clinicians. Thus, hospital-based systems are needed to help implement monitor and assess all of the processes from field, ED, in-patient beside clinician, ICU etc.
Identification
Recent findings suggest that alterations in traditional hemodynamic parameters, such as blood pressure and heart rate, are poor predictors of the presence of septic shock. Other more subtle findings (such as the capillary refill, tachypnea, mental status and others i.e. 10 SOV) are early signs and stronger determinants of poor tissue perfusion and severity of illness in a septic patient.
Treatment
Early detection of a patient who is ‘in trouble’ on the ward by bedside nurses or physicians and activation of a Rapid Response Team (RRT) has been shown to improve outcomes. By coupling education of front line providers on early recognition with the RRT with prompt best practice therapy, patients with sepsis can be identified earlier and have therapy instituted within the so-called “golden hour”.
Summary
The institution of a rapid response system for the detection and treatment of septic shock requires a multidisciplinary approach. The infrastructure to create such a system must be facilitated by administrators and implemented by front-line clinicians. Continuous assessment of outcomes by a the quality assurance team is the final part of a truly integrated approach to sepsis treatment.