Sepsis: Evaluating The Evidence

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Sepsis: Evaluating The Evidence

May 2008


The septic patient can often be the most challenging patient to manage in the ED. There is the initial challenge of identifying a potentially septic patient before the systemic derangements occur, then invasive procedures needed for resuscitation and monitoring, and finally the difficulty of deciding which are the appropriate data to collect and interventions to implement. In attempting to identify evidence to support decision making, difficulty arises immediately due to the absence of a single gold standard marker of the disease, meaning that the very definition of the disease process relies on the lowest level of evidence, a consensus statement.1 While this allows us to apply the label to those we know to be ill, it can make the study and epidemiology more complex. There is an enormous burden on society from the disease, with as many as 700,000 cases of severe sepsis per year in the U.S. and a mortality of approximately 40%.2 It is estimated that a 25% reduction in mortality in sepsis could save 50,000 lives per year in the U.S., with 1.1 million lives saved worldwide.3 This disease process is a challenge, but it also creates an opportunity for emergency medicine to play a critical role in improving outcomes.4

Application of the available evidence can have an immediate impact in reducing morbidity, mortality, and even cost in sepsis care.6–8 This issue of Emergency Medicine Practice presents a best-evidence approach to the management of sepsis. It focuses on the pathophysiology, identification, and classification of sepsis, early interventions, implementation of graded, systematic responses targeting the most aggressive care to the appropriate patients, and disposition encouraging enhanced synergy with intensivists.

Table Of Contents:

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