Treating Sepsis Like a CodeNovember 6, 2017
Sepsis is the leading cause of death in U.S. hospitals.
Mortality increases 7.6% every hour that treatment is delayed.
Dr. Jacob Shepherd, a family medicine resident in Kansas City, Mo., has a keen observation on the value of taking quick action in sepsis cases:
“We need to think about sepsis like we do a code. It’s very time sensitive,” Dr. Shepherd says. “With a cardiac arrest, there’s a sense of urgency, and we need to start thinking of sepsis the same way. We need to think about it as an acute case, because the faster you diagnose and start treating sepsis, the better the patient outcomes will be.”
Dr. Shepherd was recently working through Docs Who Care, an organization that provides medical staff coverage at community hospitals in the Midwest. He was working at a critical access hospital in Iowa, located about 1.5 hours outside of Iowa City.
The ER team that weekend consisted of Dr. Shepherd, one nurse and one paramedic. They had five other patients in the hospital when the paramedic brought in a patient from the long-term care facility who had a number of chronic conditions.
Dr. Shepherd used the Redivus Health sepsis identification app to assess the patient. He found that the patient met three of the four SIRS criteria (Systematic Inflammatory Response Syndrome), before they ran labs. The patient’s SIRS criteria included elevated body temperature, elevated heart rate and elevated respiratory rate.
Following the Redivus app’s evidence-based instructions, Dr. Shepherd and the nurse started the patient on fluids and antibiotics within 30 minutes. When the labs returned, the patient had a significantly elevated white blood cell count and a source of infection. He was initially hypotensive and once started on IV fluid boluses, his blood pressure stabilized.
“The big thing with sepsis is to hit all the steps,” Dr. Shepherd explains. “The way patients will survive is to identify sepsis quickly and start treatment early. The sepsis guidelines are about giving appropriate treatments (fluid and antibiotics) at the appropriate times and closely tracking the patient’s vital signs and lactate levels. The app’s timers are so helpful to keep track of the steps, as well as the 3-hour and 6-hour treatment bundles.”
Since the critical access hospital did not have an Intensive Care Unit, the ER team made the call to transfer the patient to the larger medical center in Iowa City. They arranged for transfer by emergency helicopter so the patient could receive quick access to the care needed.
Their quick action diagnosing and starting treatment for sepsis helped stabilize the patient for transfer.
“It was great to have the documentation from the Redivus app to send along with the patient on the helicopter,” Dr. Shepherd says. “It helps with continuity of care during transfers so the receiving hospital can see the steps we’ve taken to treat the patient.”