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Approach To Septic Shock And Severe Sepsis In Prehospital Conditions

Sepsis is a systemic, deleterious host response to infection leading to severe sepsis (acute organ dysfunction) and septic shock (severe sepsis plus hypotension not reversed with fluid resuscitation). Severe sepsis and septic shock are major health care problems affecting millions of people each year, killing one in four and increasing in incidence. The Surviving Sepsis Campaign was initiated in 2002 as a joint collaboration committed to reduce mortality from severe sepsis and septic shock worldwide. Many emergency departments have implemented sepsis protocols, which include early identification of septic patients, rapid and appropriate fluid resuscitation, laboratory tests (serum lactate and blood cultures), early antibiotic administration and source control of infection. In ICU there are bundles to be completed within three and six hours. Targets for quantitative resuscitation are CVP of ≥8 mmHg, central venous oxygen saturation of ≥70 %, and normalization of lactate. Studies have consistently shown that, even in the case of hemodynamic stability, elevated lactate levels are associated with increased mortality. Therefore, there is need for early measurement of lactate levels in the emergency department as a reasonable biomarker alternative to invasive resuscitation monitoring.

Dubravko Huljev, huljev@hitnazg.hr
Educational Institute for Emergency Medical Services City of Zagreb,
Zagreb, Croatia

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