A lot of NYC hospitals want a non-invasive protocol for severe sepsis treatment. This is the one we are working on. If you get a chance take a look and tell me what you think in the comments section. I personally would be going invasive on many of these patients. But when surveyed, many ED docs have made it clear that they will not be placing central lines in normotensive patients.
–Scott
photo by zacwitnij
Scott Weingart
An ED Intensivist from NY.
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Dr scott Everything looks good but one special catagory take care- old age with chest origin sepsis maintaining hemodynamics with your prtocol but if problem is sat 89 %90% better to intubate early as they will crsh like hell .
what is your say have you exprienced it ? If not take it -may be with a little salt.
Dr piyush (KUWAIT)
Dr. Piyush,
I definitely agree and in my personal practice, I wind up intubating almost all of my elderly patients with severe sepsis even if their saturations are holding. Old folks don’t do so swell with prolonged respiratory rates of 40-50.
scott
Scott:
Critical Care Ultrasound as per Daniel Lichtenstein( Paris)and Vicki Noble(Boston) have shown the advantage,ease and velocity which allows for diagnosis and better treatment of these patients.
I am suprised to have many of my own still request “a line”…
Raul
yep, in the hands of a skilled ultrasonographer; invasive monitoring becomes less attractive. Only annoying thing is no real-time monitoring.
Scott
I’m and ER doc and sepsis lead for my hospital. It is a large west coast “chain”. Regionally, my company recommends and somewhat enforces adoption of a rigid interpretation of River’s protocol. Personally, I have been pushing adoption of a non-invasive protocol. Any advice on how to get a large company to buy into a non-invasive strategy?
Thanks,
Scott G
well we will be publishing our first 12,000 patients. Also the Jones trial was fairly definitive. Other than that there will soon be CMS regs to follow strict EGDT so it may all be for naught.
Reavillmed is a central line placed through an IV infusion and it can be done in about 1 minute in the ER and obtain Central Venous Pressure (CVP) You can this central line to validate the higher level DRGs and take advantage of the CPT reimbursements available for central lines placed BEFORE admission. Only ReavillMED can help in this way. It is FDA approved. The central line is encased in sterile tubing and I have video of a placement and the doctor is wearing his football teams t-shirt in the ER while doing it. The survinging Sepsis Campaign: International guidelines for Management fo Severe Sepsis and Septic shock: 2012 call for the placement of a central line within 6 hours. I have an electronic copy of the report I will gladly send to anyone requesting it.