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Recognising and managing severe sepsis in the pre-hospital environment

05 November 2012
Features
02 November 2012
Volume 4 · Issue 11

Abstract

Severe sepsis is a complex medical condition in which the immune system overreacts to an infection leading to circulatory shock and organ failure. Patients with severe sepsis are critically ill and have a high mortality rate in the absence of early aggressive treatment, however, recognition and treatment of the condition remains poor. Recent improvements in the care of patients with myocardial infarction, stroke and multiple trauma have demonstrated how pre-hospital recognition and treatment can greatly improve outcomes for patients, and paramedics are well placed to provide similar improvements to the care of patients with severe sepsis. This article will explore the pathophysiology of sepsis, the recommended treatment bundles suggested by the ‘sepsis six campaign’ and the difficulties faced in implementing such treatments. Finally, it will explore the interventions that could be undertaken by Paramedics to improve patient care.

Patients with severe infections and sepsis frequently present to emergency departments, with many of these patients being transported by ambulance services. Septic patients account for 27 % of admissions to intensive care units in England (Robson et al. 2009) and are responsible for 50 % of critical care resources (Daniels et al, 2011). Their average hospital stay is four weeks (Robson et al. 2009) with 37 000 patients dying of sepsis in the UK each year (Daniels et al, 2011).

In spite of clear treatment guidelines produced by the European Society of Critical Care Medicine and the Society of Critical Care Medicine, patients with sepsis still have a mortality six times greater than those presenting with acute myocardial infarction and five times greater than those presenting with acute stroke (Cronshaw et al. 2011).

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Early goal directed therapy
Pre-hospital
Sepsis
Shock
Surviving sepsis campaign
SIRS