This study will have two versions written about it. This version is my “cut the fat” version I am trying encapsulate in this blog. As well, with my venture in medical free lance writing, I will have a “medical education” category for those who want the juicy morsels of dense medical language.
With out further wait… here is sepsis study on a plate.
Sepsis is a hot button topic in the world of prehospital medicine. There has been alot of literature put out by hospitals that declare more than 50% of in hospital deaths are due to multiple organ death (MODs), which is the ultimate deathly out come of sepsis.
The problem with sepsis and EMS is not only figuring out what we are looking for, but also to relay to the ER what we are seeing. Granted, we are not allowed to fully “diagnose” a patient, but effect EMS education teaches differential diagnosis to create a “field diagnosis.” We want to start drawing the picture of what the patient will need for continuity of care. Depending where you work, ER nurses and docs alike appreciate a field diagnosis. Again, depending where you work. In order to have that continuity of care, the EMS provider has to be ready to give the facts and findings of your field diagnosis.
Center stage at hospital night at the Apollo. Your are taking your patient to bay 1. There are 20 people in lead vests and gowns and goggles. You begin to speak loudly (que Eminem walking to the mic) and clearly. Then you are interrupted by questions you don’t know. The whole set falls apart. The crowd begins to boo. The doctors glare. The nurses snicker. The a clown with a long curved cane scoops you up and drags you to the ambulance bay…
But never fear! Sepsis study’s for ambulances are here!
For a potential Sepsis activation, you need to first understand the steps of infection and it’s relation to the human body. I’m sure many of us have had the case of chest pain that ended up being pneumonia. Productive cough? Elevated temp? Could still be cardiac but through our deferential diagnosis we know we have a higher chance or treating pneumonia instead of angina. Breathing treatment and fluid versus aspirin/nitro.
There are three steps in the chain of fatal sepsis. First step is Systemic Inflammatory Response. This is the time when majority of people of who feel ill take tylenol and get rest. The body is giving basic signals that it is fighting an infection.
Next is Sepsis. This in an untreated infection. The infection is now spreading into the blood stream (septicemia) and fluids begin shunting to organs to protect the body from shutting down. A patient can be altered, have low BP, elevated heart rate, tachypnia and elevated temperature. The blood vessels dilate, in effort to protect the organs, and the patient starts to present with signs of shock.
“The situation is usually made worse by the damaging effects of the toxins on tissues combine with the increased cell activity caused by accompanying fever.”
The next phase can be the deadly end. Multiple Organ Death (MODs) is when one by one the organs begin dying off. The body begins losing the battle against the infection.
EMS’s mission in this equation is early recognition.
Criteria for sepsis activation in prehospital is still developing. IStats. Sports medicine lactate testers. Many tools have been dropped off in our jump bags.
A study performed in Albequre, New Mexico, hospitals worked along side EMS in order to start prehospital sepsis activation. The study hypothesized that, “in patients that EMS sepsis alert criteria, there is a strong relationship between prehospital ETCO2 readings and the outcome of diagnosed infection. The secondary hypothesis was that ETCO2 also predicted hospital admission, ICU admission and death.”
Yup. The same tool used to treat respiratory problems and help declare ROSC can be extremely useful in alerting the hospital if your patient is about to go into septic shock.
Alburqure created a field sepsis protocol. Hospital alerts were initiated if there was a suspicion of infection and certain criteria met with; temperature reading >38.3 or <36 c, heart rate greater than age expectation, hypotension, elevated lactate readings, elevated respiratory rate, and hypocapnia.
As with any form of shock, a body that is in a sepsis state compensates to save valuable life saving organs. As vessels begin to shunt, you have standard shock symptoms included with infection symptoms.
So what was the result with the study?
Out of the 351 patients that met criteria over the course of a year for Field Sepsis, all patient’s MET the criteria! It worked!! EMS was successful in diagnosing sepsis in the field. Plus, they created a form of communication and trust with their local hospital.
I know many of us are cardiology gurus. We love what we can fix in the field. Truly, it is amazing what we can do to the human heart for survival. Now infection is the next focus for saving lives.
Study quoted: Sepsis alerts in EMS and the results of pre-hospital ETCO2; from American Journal of Emergency Medicine, 2018
From the hospital view. https://emcrit.org/pulmcrit/ssc-1-hour/