Sepsis

emtb2rn, BSN, RN, EMT-B · Jan 14, 2016

Agree with jrwest about sepsis by criteria. I had a 30ish female last night who met the current criteria and her dx? Hot ap, not burst, headed to the or.

Libby1987 · Jan 14, 2016

We've had so many patients with urosepis, didn't they just used to call it pyelonephritis? That's the common dx I remember from way back when and I rarely hear it anymore.

AJJKRN · Jan 14, 2016

Yes, sometimes. But lactate can be elevated because of anything collapsing peripheral circulation/disrupting glucose metabolism. Alone, it is just another number.

I meant for lactate to be used along with the other sepsis parameters AND Pt presentation.

So far it's been pretty darn useful in detecting developing sepsis.

As for the post on the "hot appy", my facility would have treated the same way = OR, finding the appy meant they found the source of infection and treated appropriately.

For the most part our sepsis protocols try and detect otherwise overlooked developing S&S of sepsis in Pt's that either have a known infection or are suspected to be showing S&S before they completely tank on us.

It's just a bit bittersweet for me that the push to save lives and educate about early sepsis prevention/treatment/education has more to do with making sure we get paid in full by the government as opposed to doing so because it's the right thing to do...

iluvivt, BSN, RN · Jan 14, 2016

I meant for lactate to be used along with the other sepsis parameters AND Pt presentation.
So far it's been pretty darn useful in detecting developing sepsis.
As for the post on the "hot appy", my facility would have treated the same way = OR, finding the appy meant they found the source of infection and treated appropriately.
For the most part our sepsis protocols try and detect otherwise overlooked developing S&S of sepsis in Pt's that either have a known infection or are suspected to be showing S&S before they completely tank on us.
It's just a bit bittersweet for me that the push to save lives and educate about early sepsis prevention/treatment/education has more to do with making sure we get paid in full by the government as opposed to doing so because it's the right thing to do...

It's the same feeling with Central line related bloodsteam infections.For years I was advocating for better and more consistent care and it was not until there was a potential loss of reimbursement that anyone cared.

Nonyvole, BSN, RN · Jan 14, 2016

In my ED, we'll hit the SIRS criteria with a handful of patients, but then we do try to use our brains and look for a possible source of infection. Like that massive abcess. Pneumonia. Urine that looks like sludge instead of, well, urine. After that we do the rest of the sepsis evaluation with labs.

Really, it comes down to acknowledging that the screening is a useful tool, but that there are other things that can affect it. (I hate the fact that a lactate of >4 will say that somebody is in septic shock. They have a MAP of 67 that's holding steady without tons of fluid, they have a better urine output than I do...case in point. Patient has a lactate of 7. One liter of fluid later - hush, it really did take 3 hours for a liter bolus because they're a chronic IV drug user and all we could get was a 24 in the wrist - and their repeat lactate is 2. Deemed septic because they do have a source of infection, but they're getting up and chatting with us at the desk, asking for water, yes, they've a white count of 22 but the rest of their labs aren't that crazy. Don't think that they're in shock.)

Or, this is all another deal of treating the monitor, and not the patient.

NICUNurseEliz · Jan 14, 2016

We've had so many patients with urosepis, didn't they just used to call it pyelonephritis? That's the common dx I remember from way back when and I rarely hear it anymore.

Pyelonephritis as a diagnosis is simply stating that the patient has a kidney infection. Urosepsis is acknowledging that the patient has clinical indications of sepsis (ranging from SIRS to septic shock) plus the known source of infection, originating as a UTI/pyelo.

I'm guessing the shifting of terms is related to the JC/DNV push to recognize and aggressively treat sepsis earlier.

iShaybie, ADN · Jan 16, 2016

Pyelonephritis as a diagnosis is simply stating that the patient has a kidney infection. Urosepsis is acknowledging that the patient has clinical indications of sepsis (ranging from SIRS to septic shock) plus the known source of infection, originating as a UTI/pyelo.
I'm guessing the shifting of terms is related to the JC/DNV push to recognize and aggressively treat sepsis earlier.

This was my case !

NICUNurseEliz · Jan 16, 2016

This was my case !

Hope you're feeling better! I have had pyelonephritis and it's horrible! I was also surprised how quickly I got sick. I went from fine to vomiting, being febrile, having horrible flank pain, and being tachypneic and tachycardiac in less than four hours.

Since I had it, I've always tried to drink at least some water and sneak in a bathroom break at work, even when I'm crazy busy.

iShaybie, ADN · Jan 16, 2016

Hope you're feeling better! I have had pyelonephritis and it's horrible! I was also surprised how quickly I got sick. I went from fine to vomiting, being febrile, having horrible flank pain, and being tachypneic and tachycardiac in less than four hours.
Since I had it, I've always tried to drink at least some water and sneak in a bathroom break at work, even when I'm crazy busy.

Thank you!! I'm doing much much better. It was a real eye opener! It escalated SO fast!; I was surprised too! I had those same symptoms--I can't believe I didn't take them more seriously.

In just a few weeks it went from just a UTI to near-death. Lol it really taught me that I shouldn't blow things off, and to take care of myself. So I'm also drinking more water! Lol.

I couldn't see my daughter for days because I was in isolation. I was so mad at myself because if I put off treatment any longer , I might not have seen her ever again. Sooo scary!