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Sepsis kills. Once symptoms have begun, the national survival average is 51%. But Greater Regional Health has attained an 83% average in successfully treating sepsis.
The sepsis team from GRH was chosen recently to give a presentation of their methods at the National Rural Health Association’s Rural Health Clinic Conference in Kansas City, Missouri.
What is sepsis?
The Centers for Disease control defines sepsis as “the body’s extreme response to an infection. It is a life-threatening medical emergency.”
Any infection that a patient has - in the lungs or urinary tract, on the skin, or elsewhere - can lead to sepsis, where the infection spreads rapidly and can then cause a chain reaction throughout the body. If a patient with sepsis does not receive prompt, targeted treatment, it can lead to tissue damage, organ failure and death.
No magic pill
Kimberly Weehler, a member of the sepsis team and director of quality at GRH, said it’s not one big change they made, It is a series of small changes led by increased education and communication. She said it is about culture and using multidisciplinary teams to recognize the symptoms.
Dr. Steve Reeves added, “A committee with no chair leads to communication back and forth.”
All emergency room personnel from the EMTs and receptionists, who are the first to see the patients, up to the doctors themselves are trained in identifying the possibility of sepsis and have the power to call for the sepsis interventions.
“ER nurses, doctors and EMTs treat the possibility of sepsis like chest pain,” said Weehler. “Even if the receptionist is really worried,” they can ask for the patient to be seen right away.
Early identification is key to treating sepsis. Once the possibility is determined a specific protocol begins. If a patient is being transported by ambulance, the EMTs can begin an IV to treat or prevent dehydration. Dehydration can cause low blood pressure, which restricts blood flow to the internal organs. They also alert the ER to the situation so that the correct antibiotics can be ready for administration.
Once the patient arrives at the ER, either by ambulance or as a walk-in patient, the “Hour-1 Bundle” begins. Blood cultures are taken to measure lactate levels and then broad-spectrum antibiotics are given. If the results of the lactate levels are elevated or the patient’s blood pressure is low, crystalloid — a solution of mineral salts and other small, water-soluble molecules — is given. If fluid resuscitation does not relieve the low blood pressure, vasopressors are given to restrict the blood vessels and raise the blood pressure.
Weehler said GRH’s current guidelines are to administer the sepsis protocol within three hours, but the staff is striving to reduce that time to one hour.