Great lecture: Prehospital Sepsis by Luke Duncan, MD, Albany Medical Center

• Audio Link
  Video Link

Some pearls…

Identifying sepsis early is a key component of good outcomes

Simply saying the word “sepsis”or “septic” on your report will get the patient proper care an hour earlier!

He talks a lot about MAP – that being the new criteria for monitoring BP – much more accurate indicator – needs to be kept above 65 in order to perfuse the brain. Below 60 other end organs are affected as well. Systolic and/or diastolic may not indicate how sick the patient really is. MAP is where its at…(You can find this measurement on the Lifepak 12 /15 in bottom corner of NIBP area)

SIRS criteria for sepsis (Systemic inflammatory response syndrome)

• Tachycardia >90
• Tachypnea >20
• Temp <97°F or >100°F
• ^ White Count (Notice no BP measure here)

SIRS can be diagnosed when two or more of these criteria are present. When SIRS is due to an infection, it is considered sepsis. Noninfectious causes of SIRS include trauma, burns, pancreatitis, ischemia, and hemorrhage

Albany REMO has a great suspected sepsis protocol which uses MAP as one of the criteria. See protocol here – Lots of fluids early on, 2 liters in the field before considering pressors.

Key Points:

• Early identification saves an hour or more
• Early resuscitation saves lives
• Early antibiotics saves lives (Seattle is experimenting with paramedic administered antibiotics)

One last reminder before our finals!

Good luck!

Never forget:
1) SIFO (medical): Scene size up. Initial assessment. Focused Assessment. Ongoing Assessment.
Or
SIFDO (trauma): Scene size up. Initial assessment. Focused Assessment. Detailed assessment. Ongoing Assessment.

2) ABC DEFG (airway, breathing, circulation, disabilities, extremities, full vitals, GO).

3) IPASSO (inspect, palpate, auscultat, stabilize, seal, O2).

4) OPQRSTI (onset, provocations, quality, radiation, severity, time, interventions).

5) SAMPLE (signs/symptoms, allergies, medications, past hx, last intake, events).

6) Pertinent questions regarding call: eg. weight, LMP, PARA, Gravada, drug consumption, Etoh, smoking, etc.

Detailed Exam:* Head to toe assessment *Pay close attention to JVD, Ascites, Pedal Edema.

By Miguel

"This is why people fail exams and/or lose their certifications"

Rule #1: BLS before ALS.

Rule #2: Treat your patient not the monitor.

Rule #3: An ‘excellent’ EMT = a ‘good’ medic.

Rule #4: Protocols are guidelines, not set in stone.

Rule #5: Refrain from getting tunnel vision.

Never forget:

1) ABC DEFG (airway, breathing, circulation, disabilities, extremities, full vitals, GO).

2) IPASSO (inspect, palpate, auscultate, stabilize, seal, O2).

3) OPQRSTI (onset, provocations, quality, radiation, severity, time, interventions).

4) SAMPLE (signs/symptoms, allergies, medications, past hx, last intake, events).

5) Pertinent questions regarding call: ex: weight, LMP, PARA, Gravada, drug consumption, Etoh, smoking, etc.

* Head to toe assessment *

** approximately 40 questions before you begin ALS, unless the call is obvious **

Rookie Mistakes:

#1 Uses monitor for everything.

#2 Every call becomes ALS.

#3 Every chest pain is cardiac.

#4 Every patient gets an IV.

** don’t go by what the EMT’s tell you **

***Become a Clinician***

Steve’s Orderly approach to physical exam

• Scene Safety/BSI/Social Environment
• Age
• Sex
• Chief Complaint
• HPI – elaboration of C/C – OPQRST
• PMH (Past Medical History) – SAMPLE
• PE – Physical Exam
  • LOC
  • JVD
  • Lung Sounds
  • Hearts Sounds
  • Pedal Edema & Presacral Edema
• BLS
• Diagnostics
• ALS