Emergency Department, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK.
Emerg Med J. 2011 Aug;28(8):670-5. doi: 10.1136/emj.2009.089581. Epub 2010 Jul 26.
Severe sepsis/septic shock (SS/SS) has a high mortality. The past decade lays witness to a concerted international effort to tackle this problem through the Surviving Sepsis Campaign (SSC). However, bundle delivery remains problematic. In 2009, the College of Emergency Medicine (CEM) set out guidelines for the management of SS/SS. These set the standards for this audit.
To assess the recognition and management of patients presenting with SS/SS across three emergency departments (EDs) within the West Midlands.
Data were collected retrospectively over a 3-month period. Patients in the ED with a diagnostic code of, or presenting complaint suggestive of, sepsis, had their scanned notes assessed for evidence of SS/SS. Compliance with the CEM guidelines, and evidence of referral to the intensive care staff was evaluated.
255 patients with SS/SS were identified. Of these, 17% (44/255) were documented as septic by ED staff. The CEM standard of care was received in 41% of those with a documented diagnosis of severe sepsis in the ED, and 23% of patients with SS/SS overall. 89% of patients received the 'treatment' aspects of care: oxygen, IV antibiotics and IV fluids. Twelve patients with a raised lactate level and normal blood pressure (cryptic shock) failed to receive fluid resuscitation. 71% of patients with SS/SS had no documented discussion or consideration of referral to the intensive care unit.
The SSC has had some impact; however, there is still a long way to go. It is assumed that the picture is similar in EDs across the UK and recommendations are made based on these local findings.
严重脓毒症/脓毒性休克（SS/SS）的死亡率很高。在过去的十年中，国际社会通过脓毒症存活运动（SSC）共同努力解决这一问题。然而，捆绑包的实施仍然存在问题。2009 年，急诊医学学院（CEM）制定了 SS/SS 管理指南。这些指南为本次审计设定了标准。
评估在西米德兰兹地区的三个急诊部（ED）中出现 SS/SS 的患者的识别和管理情况。
在三个月的时间里，我们回顾性地收集数据。在 ED 中，有诊断代码为或有提示败血症的主诉的患者，对其扫描的病历进行评估，以确定是否存在 SS/SS。评估对 CEM 指南的遵守情况以及向重症监护人员转诊的证据。
确定了 255 例 SS/SS 患者。其中，17%（44/255）被 ED 工作人员记录为败血症。在 ED 中有明确诊断为严重败血症的患者中，有 41%接受了 CEM 标准治疗，而总体 SS/SS 患者中则有 23%接受了治疗。89%的患者接受了治疗方面的护理：吸氧、静脉抗生素和静脉补液。12 例乳酸水平升高但血压正常的患者（隐匿性休克）未接受液体复苏。71%的 SS/SS 患者没有记录讨论或考虑转至重症监护病房。
SSC 已经产生了一些影响；然而，仍有很长的路要走。据推测，英国各地的 ED 情况都类似，并根据这些本地发现提出了建议。
