The Role of Nursing, Emergency Medicine, and Laboratory Services in the Early Detection and Management of Sepsis in Emergency Settings
DOI:
https://doi.org/10.22399/ijcesen.3953Keywords:
Sepsis, emergency settings, nursing, emergency medicine, laboratory services, early detectionAbstract
Sepsis is a life-threatening condition that arises when the body's response to infection leads to organ dysfunction. In emergency settings, the timely identification and management of sepsis are crucial for improving patient outcomes. Nursing professionals play a vital role in the early detection of sepsis by conducting comprehensive assessments, monitoring vital signs, and recognizing the signs and symptoms of infection. Their ability to communicate critical findings to the emergency medicine team is essential for initiating prompt interventions. Emergency medicine practitioners are responsible for implementing evidence-based protocols designed to manage sepsis effectively, including the administration of intravenous fluids, broad-spectrum antibiotics, and monitoring for signs of organ failure. The collaboration between nursing and emergency medicine teams is pivotal in ensuring that patients at risk of or suffering from sepsis receive rapid and appropriate care. Laboratory services further enhance the early detection and management of sepsis in emergency settings. Rapid diagnostic testing, including blood cultures and biomarkers such as procalcitonin, aids healthcare providers in confirming the presence of infection and determining its severity. Timely laboratory results empower clinicians to make informed decisions regarding treatment strategies, which can significantly impact patient survival rates. By integrating nursing expertise, emergency medicine protocols, and laboratory capabilities, healthcare facilities can improve the overall response to sepsis, leading to better patient outcomes and reducing mortality associated with this critical condition. This multidisciplinary approach ensures that all aspects of patient care are addressed, fostering a seamless continuum from assessment to treatment.
References
[1] Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810.
[2] Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589-1596.
[3]Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015;372(17):1629-1638.
[4] Freund Y, Lemachatti N, Krastinova E, et al. Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department. JAMA. 2017;317(3):301-308.
[5] Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762-774.
[6] Odell M, Gerber K, Gager M. Nurse recognition and response to signs of clinical deterioration. Nurs Stand. 2019;34(6):45-50.
[7] Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021;49(11):e1063-e1143.
[8] Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 update. Intensive Care Med. 2018;44(6):925-928.
[9]Puskarich MA, Trzeciak S, Shapiro NI, et al. Outcomes of patients undergoing early sepsis resuscitation for cryptic shock compared with overt shock. Resuscitation. 2011;82(10):1289-1293.
[10]Schuetz P, Wirz Y, Sager R, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev. 2017;10(10):CD007498.
[11]Burney M, Underwood J, McEvoy S, et al. Early detection and treatment of severe sepsis in the emergency department: identifying barriers to implementation of a protocol-based approach. J Emerg Nurs. 2012;38(6):512-517.
[12]Rhee C, Dantes R, Epstein L, et al. Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014. JAMA. 2017;318(13):1241-1249.
[13]Paoli CJ, Reynolds MA, Sinha M, Gitlin M, Crouser E. Epidemiology and Costs of Sepsis in the United States-An Analysis Based on Timing of Diagnosis and Severity Level. Crit Care Med. 2018;46(12):1889-1897.
[14]Gotts JE, Matthay MA. Sepsis: pathophysiology and clinical management. BMJ. 2016;353:i1585.
[15]Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31(4):1250-1256.
[16]Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015;372(17):1629-1638.
[17]Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810.
[18]Freund Y, Lemachatti N, Krastinova E, et al. Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department. JAMA. 2017;317(3):301-308.
[19]Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 update. Intensive Care Med. 2018;44(6):925-928.
[20]Seymour CW, Gesten F, Prescott HC, et al. Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. N Engl J Med. 2017;376(23):2235-2244.
[21]Bullock B, Benham MD. Bacterial Sepsis. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537054/
[22]Moore J, Coady K, Aitken LM. The impact of a nurse-led sepsis initiative on time to initial antibiotic administration and in-hospital mortality. Aust Crit Care. 2020;33(3):258-264.
[23]Odell M, Gerber K, Gager M. Nurse recognition and response to signs of clinical deterioration. Nurs Stand. 2019;34(6):45-50.
[24]Fok PT, Teja B, Ouyang B, et al. The Association Between Triage Nurse Clinical Experience and the Accuracy of Sepsis Recognition. Ann Emerg Med. 2022;80(4S):S19-S20.
[25]Beckett CD, Kipnis G. Collaborative communication: integrating SBAR to improve quality/patient safety outcomes. J Healthc Qual. 2009;31(5):19-28.
[26]Dawson S. Blood culture contaminants. J Hosp Infect. 2014;87(1):1-10.
[27]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med. 2020;21(2):e52-e106.
[28]Messmer AS, Zingg C, Müller M, Gerber JL, Schefold JC, Pfortmueller CA. Fluid Overload and Mortality in Adult Critical Care Patients-A Systematic Review and Meta-Analysis of Observational Studies. Crit Care Med. 2020;48(12):1862-1870.
[29]Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS One. 2018;13(8):e0203316.
[30]Wong A, Otles E, Donnelly JP, et al. External Validation of a Widely Implemented Proprietary Sepsis Prediction Model in Hospitalized Patients. JAMA Intern Med. 2021;181(8):1065-1070.
[31]Casserly B, Phillips GS, Schorr C, et al. Lactate measurements in sepsis-induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database. Crit Care Med. 2015;43(3):567-573.
[32]Puskarich MA, Trzeciak S, Shapiro NI, et al. Prognostic value and agreement of achieving lactate clearance or central venous oxygen saturation goals during early sepsis resuscitation. Acad Emerg Med. 2012;19(3):252-258.
[33]Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2016. Intensive Care Med. 2017;43(3):304-377.
[34]Marik PE, Linde-Zwirble WT, Bittner EA, Sahatjian J, Hansell D. Fluid administration in severe sepsis and septic shock: patterns and outcomes--an analysis of a large national database. Intensive Care Med. 2017;43(5):625-632.
[35]Loubani OM, Green RS. A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. J Crit Care. 2015;30(3):653.e9-17.
[36]Marshall JC, al Naqbi A. Principles of source control in the management of sepsis. Crit Care Clin. 2009;25(4):753-768.
[37]Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283-1297.
[38]Annane D, Renault A, Brun-Buisson C, et al. Hydrocortisone plus Fludrocortisone for Adults with Septic Shock. N Engl J Med. 2018;378(9):809-818.
[39]Riesenberg LA, Leitzsch J, Massucci JL, et al. Residents' and attending physicians' handoffs: a systematic review of the literature. Acad Med. 2009;84(12):1775-1787.
[40]Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 update. Intensive Care Med. 2018;44(6):925-928.
[41]Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA; Emergency Medicine Shock Research Network (EMShockNet) Investigators. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010;303(8):739-746.
[42]Wacker C, Prkno A, Brunkhorst FM, Schlattmann P. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(5):426-435.
[43]Schuetz P, Wirz Y, Sager R, et al. Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory tract infections: a patient level meta-analysis. Lancet Infect Dis. 2018;18(1):95-107.
[44]de Jong E, van Oers JA, Beishuizen A, et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. Lancet Infect Dis. 2016;16(7):819-827.
[45]Tabah A, Bassetti M, Kollef MH, et al. Antimicrobial de-escalation in critically ill patients: a position statement from a task force of the European Society of Intensive Care Medicine (ESICM) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Critically Ill Patients Study Group (ESGCIP). Intensive Care Med. 2020;46(2):245-265.
[46]Crowley K, Kline JA. The effect of emergency department lactate elevation on time to antibiotics in patients admitted with suspected infection. J Emerg Med. 2013;44(3):616-622.
[47]Byrne L, Van Hise S, McNamara R, et al. Point-of-care lactate testing for sepsis at emergency department triage: a pilot study. CJEM. 2020;22(2):202-207.
[48]Howanitz PJ, Steindel SJ, Heard NV. Laboratory critical values policies and procedures: a college of American pathologists Q-Probes study in 623 institutions. Arch Pathol Lab Med. 2002;126(6):663-669.
[49]Timbrook TT, Morton JB, McConeghy KW, Caffrey AR, Mylonakis E, LaPlante KL. The Effect of Molecular Rapid Diagnostic Testing on Clinical Outcomes in Bloodstream Infections: A Systematic Review and Meta-analysis. Clin Infect Dis. 2017;64(1):15-23.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 International Journal of Computational and Experimental Science and Engineering

This work is licensed under a Creative Commons Attribution 4.0 International License.