The latest video in the EMS1.com “2 Things” video series from Steve Whitehead. Early identifcation and early resuscitation. Great stuff Steve!

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Reader writes, “I am looking for more information on Severe Sepsis is treated.” A quick Google search revealed these resources:

• Guidelines for management of severe sepsis and septic shock
• Treatment and drugs for Severe Sepsis
• Diagnosis and treatment of severe sepsis

Also, check out this excellent EMS World article about Severe Sepsis and a Sepsis Alert.

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A patient care protocol is a kind of checklist. A protocol includes a lot of instructions on how to assess and treat a patient. Within a protocol you might also have several checklists to complete to successfully implement the protocol.

For example, you likely have a protocol for a patient with chest pain. The protocol directs assessment of the patient’s pain and measurement of vital signs. It may also direct initial patient treatments. The protocol may also include a checklist of specific actions:

1. Administer medications
2. Acquire, read, and transmit 12-lead

A chest pain protocol may also include a checklist for preparing the patient for the cath lab:

1. Remove patient’s clothing
2. Start at least one IV
3. Shave the patient’s groin
4. Document specific patient history findings

Checklists can also be useful for situations where additional care providers will arrive on-scene to verify that actions have been taken. For example, a cardiac arrest checklist for the second arriving unit might be focused on first assuring minimal interruptions to chest compressions, before other interventions. A later arriving responder, not in the thick of the action, might be best suited to step back and verify completion of assessment and treatment actions with a checklist.

Some specific situations well suited for a checklist:

1. Cardiac arrest
2. Stroke
3. Sepsis
4. Respiratory failure

Do you use checklists? Do you think a checklist is different from a protocol? How can checklists improve patient care and EMS professional safety?

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This statistic really caught my attention – “Severe sepsis is fatal in 1 of four cases and will kill more than a million American’s this year.” A disease, or results of the disease, kills as many people as breast and lung cancer combined yet we hardly know anything about.

Most of what I recall learning about sepsis has come in the context as a cause for shock. The inflammatory response from a septic infection causes systemic vasodilation. Significant signs include hypotension, tachycardia, and tachypnea. The patient may or may not be febrile. Usually, a cause for infection can be identified during the patient assessment process. I have most often encountered septic patients that initially had a urinary tract or respiratory infection. Recent invasive procedures and illnesses that result in immunosuppression are also causes of sepsis.

A Sepsis Alert
Paramedic, EMS Educator, and Blogger Steve Whitehead has written an excellent article for EMS Magazine about Severe Sepsis and the Denver Metropolitan Sepsis Alert Program. The protocol equips EMS professionals to identify sepsis, initiate treatment, and activate a sepsis alert at the receiving hospital. Early identification and intervention can reduce patient mortality. Make sure you read Steve’s article. (the statistics in the introduction paragraph of this post came from Steve’s article).

Sepsis CE Lesson

Learn more about sepsis from a RapidCE lesson that discusses the physiology and treatment of sepsis. Successfully complete the lesson to earn 1.0 CECBEMS approved CE credits. Comments from previous students.

“Good course should be mandatory for all EMS providers.” Paramedic user comment

“Awesome review. Thank you!” Paramedic user comment

“This lesson was well done, for rather complex subject.” EMT user comment

“Excellent course.” EMT user comment

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Urinary tract infections, infected pressure sores, and lower respiratory infections are initially local infections. If assessed and treated early these infections can be contained to that location. Unfortunately, as Everyday EMS Tips readers, are well aware local infections can go unnoticed, especially in bed confined patients, for days.

I am sure you have responded to calls that go something like this:

“We thought she might have a UTI. Now today she has developed a high fever.”

“The doctor has been treating pressure sores on the patient’s ankles, but now we see red streaks running up the patient’s legs.”

“He has been coughing for days, but now he has a fever, I can’t get him to wake up, and his blood pressure is really low.”

Any of these patients could (and likely is) septic. As an EMS professional you need to:

1. Remember your role in preventing local infection by always washing your hands, using appropriate PPE to protect you and the patient, and practice aseptic technique.

2. Learn more about the causes, risks, and prevention strategies for healthcare acquired infections from the CDC Website.

3. Get in the habit of assessing the oral temperature of any patient that has or you suspect has a local or systemic infection. Fever is a sign of sepsis.

4. Read this short and informative blog post from the iTriage health blog about Sepsis. Three of the four criteria for Severe Inflammatory Response Syndrome (SIRS) can be assessed by any EMS professional.

5. Follow your local protocols for a confirmed or suspect septic patient. Care may include airway management, ventilation support if indicated, high flow oxygen, IV access for fluid administration, and even medications if the patient is hypotensive.

You can learn more about Sepsis in a CE lesson from RapidCE.com that was written by Critical Care Paramedic Kevin T. Collopy. The lesson covers the recognition, assessment, and treatment of sepsis by EMS Professionals.

How can EMS professionals help prevent healthcare acquired infections?

This is the fifth installment of the EverydayEMSTips.com series of posts for December, 31 Days of Con Ed.

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