Read yet another article today highlighting the beneficial effects of early goal directed therapy in sepsis. Wondering what the thoughts of others are on treating sepsis early in the prehospital setting. I'm thinking that if you had at least 20 min transport this might show some benefit for the sicker patients. Identification by history, vitals, and point of care lactate could narrow down patients that would actually benefit. Maybe a protocol combining oxygen therapy, rapid and aggressive fluid boluses, and possibly broad spectrum IV antibiotics (vancomycin+ceftriaxone?).
Paramedic Sepsis Management
- Thread starter joeDO2
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EMT/Paramedics are so interested in trying to be the "hero" in the field that I'm not sure if thats the best care for patients.
If you can do all of that stuff without delaying transport to an ER, then by all means do so. My guess is that you wont be able to though. If you're talking about doing the 'protocol' while you are actually moving in teh ambulance, thats one thing. But my guess is that what happens in real life is that you are sitting at the scene trying to figure everything out and delaying transport.
I'm certainly not for any "hero"antics or anything that will not have a direct benefit to the patient. I also am not suggesting that a protocol like this be instituted while moving to the ambulance as that is not realistic. As I was saying originally, this might be a consideration with transport times >20 minutes. Although there have been multiple studies showing time benefit, here is a link to one: http://www.ncbi.nlm.nih.gov/pubmed/20048677
It was found that time from triage to antibiotics <1 hr mortality = 19.5% and >1hr = 33.2%
I would argue that a similar study with patients receiving therapy even before arrival at triage might have a more dramatic decrease in mortality of these patients. If that is found to be the case, then it certainly is in the best interest of the patient.
Also, I think that is quite the blanket statement on the motivation of paramedics and not necessarily true. Although those personalities exist, I think most want to do what evidence shows is best for their patients.
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On the positive side I think a POC lactate would probably be unnecessary. Aggressive fluid resuscitation would likely be the best course. Antibiotics would also likely be of negligible benefit prehosptial in the timeframe you are talking about. They would also introduce issues with cultures, e.g. do they get drawn by the crew before antibiotics or by the ED with ARD after the fact. This would also create issues for the hospital meeting its CMS core measure requirements so I don't think antibiotics would be feasible.
On the negative side I'd say the best bang for our buck on the EMS/Sepsis would be from advanced education. I still see too many people who are septic and tachycardic and their fever, poor turgor, infectious symptoms, etc. are all over looked while the crew treats their "SVT" with adenosine.
On the negative side I'd say the best bang for our buck on the EMS/Sepsis would be from advanced education. I still see too many people who are septic and tachycardic and their fever, poor turgor, infectious symptoms, etc. are all over looked while the crew treats their "SVT" with adenosine.
agree
D
deleted92121
The best thing a medic can do is recognize the situation based on a good history and assessment and treat properly without delaying transport. Simple as that. No need for abx in the field. If you're truly septic, good chance you end up in ICU. Let them deal with it.
