We do not have written guidelines for the *identification* of sepsis or
shock but we discuss it here every day and have for 19 years.
For the treatment of sepsis (the easier part IMHO) we follow the Critical
Care guidelines Dr. Foland shared.
With all due respect to Dr. Carcillo's outstanding lifetime of work in this
area, it is interesting to note that all the clinical gems on the early
diagnosis of sepsis have been unearthed through the retrospectoscope of the
intensivists- who get to see the patient when the cat is out of the bag.
The problem is that the progress to MODS in shock is non-linear (see Proulx
et al. Chest 1996 I believe) and requires more time than we typically have
in the ED
to figure out much of the time.
Trying to identify which febrile patient is in soon-to-be-severe-sepsis in
the ED is like
trying to identify which falling snowflakes are going to dissolve before
hitting the ground. Try it some time, it's fun.
Nietzsche (paraphrase)- "Conviction is a greater threat to the the truth....
Jay Fisher MD
Pediatric Emergency Services
Children's Hospital of Nevada
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