We have hit the 10,000 patient mark in the NYC STOP Sepsis collaborative. Here are some of the lessons learned...

Want to See the Protocols?

Recognition

* Let nurses handle recognition

Lactate

* Send lots of lactates

* Lactate turn-around 30 minutes or get Point-of-Care

* Run the lactates on a blood gas machine

* Make lactate >=4 a panic value

Treatment

* Prompt palliative vs. curative

* Non-invasive protocols have evidence and seem to be working

Want to See the Protocols?

Early appropriate antibiotics

* Empiric Abx Guidelines

* First dose of those antibiotics in the ED

* Simultaneous Infusions

Intubation

* Safe Intubation

Fluids

* Echo Assessment of Cardiac Output

* IVC ultrasound (Also check out the Stone Debate)

* If empiric fluid-loading, give 4-6 liters

Pressors

* Do a sterile neck line or a non-sterile femoral (which should be yanked and replaced as soon as the patient gets upstairs)

* Norepi should be your 1st pressor choice

Check Your Work

* Mandate repeat lactates

More Sepsis Resources

* Manny Rivers on Early Goal Directed Therapy

* A tirade on Sepsis Care in the ED (And additional follow-up) Back then there was no Non-Invasive Path

* That was until Alan Jones published his lactate clearance study

* Find a ton of evidence and other good stuff on the EMCrit Severe Sepsis Deep Dive Pages

 The Proposed NQF Measure

Read it and weep

Please contact the folks in your hospital that will be voting on the measure

On a Side Note...

EMCrit just broke the 3 Million Downloads mark. Yeah!!!!

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