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Sepsis Treatment in the ED

 

How soon after patients present in hospital emergency departments with sepsis should they receive broad-spectrum antibiotics and intravenous fluid?

a. 3 hours

b. 4 hours

c. 5 hours

d. 6 hours

Answer: a

Sepsis is the leading cause of death among hospitalized patients, so seconds matter in the effective treatment of the potentially fatal condition. Many of the 1.5 million patients who suffer sepsis each year head to emergency departments (EDs) for urgent and potentially lifesaving care.

The Centers for Disease Control and Prevention (CDC) recommend the prompt treatment of sepsis with broad-spectrum antibiotics and intravenous fluid, but not every hospital follows a standardized care plan, and controversy swirls around how rapidly sepsis should be treated.

Despite the CDC’s guidance, some experts argue the rapid treatment of sepsis carries risk of unintended side effects and distracts providers in busy EDs, according to Dr Christopher W Seymour, an assistant professor in the department of critical care and emergency medicine at the University of Pittsburgh School of Medicine. His recent study provided the first clinical evidence aimed at answering the question at the center of the debate: Does faster sepsis treatment using rapid response protocols save lives?

Dr Seymour and colleagues reviewed the outcomes of approximately 45,000 patients who were treated for sepsis and sepsis shock in the EDs of 185 hospital in New York, where the state department of health requires providers to obtain blood cultures, measure serum lactate levels, and administer broad-spectrum antibiotics within 3 hours of when patients arrive for care (New England Journal of Medicine; doi:10.1056/NEJMoa1703058).

Patients who had the 3 elements of the bundle completed within the mandated 3-hour period were 14% less likely to die while hospitalized, according to the study. The findings also showed that timely care was most important in patients with low blood pressure or chronic diseases.

Dr Seymour said the study, which offered evidence-based support for other states interested in implementing rapid care initiatives, shows faster is better when it comes to lifesaving sepsis treatments.

—Dan Cook

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