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Putting the SEP-1 Core Measure for Sepsis into Practice

Sepsis occurs when the body is fighting sever infection spread through the bloodstream. It can strike anyone, especially those who are weak due to severe illness or an impaired immune system. Providing background on the SEP-1 core measure and case studies right out of the ED, Dr. Pines shares his insights on this potentially deadly condition.

Jesse M. Pines, MD, MBA, MSCE
Director, Center for Healthcare Innovation and Policy Research, Professor of Emergency Medicine and Health Policy, The George Washington University
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Expert Presentations
Jesse M. Pines, MD, MBA, MSCE
Director, Center for Healthcare Innovation and Policy Research, Professor of Emergency Medicine and Health Policy, The George Washington University
(1,176)
170 Comments
Jesse M. Pines, MD, MBA, MSCE
Director, Center for Healthcare Innovation and Policy Research, Professor of Emergency Medicine and Health Policy, The George Washington University
(90)
8 Comments
Jesse M. Pines, MD, MBA, MSCE
Director, Center for Healthcare Innovation and Policy Research, Professor of Emergency Medicine and Health Policy, The George Washington University
(124)
14 Comments
Latest Comments
"Fluid resuscitation is only indicated for severe sepsis with initial hypotension or septic shock as evidenced by SBP < 90, MAP < 65, a drop in SBP > 40, or serum lactate ≥4 mmol/L.

There are 2 different 3 -hour clocks: one is a sepsis/severe sepsis clock and the other is a septic shock clock. If the patient presents with severe sepsis with no initial hypotension or no sign of septic shock, fluid resuscitation is not needed.

If fluid resuscitation is needed, you do not have to give it bolus. As long as the IV rate is > 125mL/hr (meaning fluid has to run at 126mL/hr or greater) and it is initiated within the 3 hour of severe sepsis with initial hypotension or septic shock presentation, you are with the guideline.

From my observation and experience, the more fluid you give, the worst the outcome is especially for those patients with existing heart failure, undiagnosed heart failure, liver failure, those with weaky, leaky heart valves (most of our elderly patients especially those post MI), cardiomyopathy, etc.

Sepsis core measure is awful. This cookie cutter approach takes away clinical judgment and critical thinking. As long as you document why any of the SIRS or organ dysfunction elements are abnormal (hypotension is related to cardiogenic shock or lactate is elevated due to post cardiac arrest or other types of shock or metformin or acute alcohol intoxication or salicylate use, etc.) and you definitely do not think that the patient has severe sepsis, you will meet the guideline.

Do not let hospital quality workers force you into doing something that is not right for your patients. We must examine outcomes (length of stay, mortality data, etc.)."
Doug Ahern, NP
Barlow Respiratory Hospital
170 Comments
"What would be the clinical research for 7-day vs. 14-day Cipro, especially if patient was also on Meripenum at admission?"
George Moussally, NP
Nurse Practitioner, Kaweah Delta Healthcare
14 Comments
 

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