Logo Elsevier

Careplan

Sepsis or Septic Shock (Adult ED)

Nov.08.2021

Sepsis or Septic Shock (Adult ED)

Clinical Description

  • Care of the Emergency Department patient seeking treatment for sepsis or associated septic shock.

Key Information

  • Signs of early sepsis include increased heart rate and decreased blood pressure, as well as changes in mental state, respiratory pattern or peripheral perfusion; signs and symptoms may progress rapidly.
  • Outcomes are improved by early identification of sepsis and the immediate initiation of evidence-based therapy following sepsis recognition, including aggressive fluid resuscitation and antimicrobial therapy.
  • A change in mental status may be the first or only symptom of infection in older adults.
  • Elevated lactic acid levels may indicate tissue hypoxia and poorer outcomes.
  • ARDS (acute respiratory distress syndrome) is highly associated with sepsis, whether it is the cause or result of sepsis. Suspect ARDS (acute respiratory distress syndrome) if PFR (ratio of partial pressure of arterial oxygen to fractional inspired oxygen) is less than 300 mmHg.

Threats to Life, Limb or Function

  • acute renal failure
  • ARDS (acute respiratory distress syndrome)
  • DIC (disseminated intravascular coagulation)
  • failure to recognize sepsis
  • multiple-organ-dysfunction syndrome
  • sepsis-associated encephalopathy
  • septic shock

Clinical Goals

By transition of care

A. The patient will achieve the following goals:
  • Goal: Acute Signs/Symptoms are Managed

  • Goal: Acceptable Pain Level Achieved

    Correlate Health Status

    • Correlate health status to:

      • history, comorbidity
      • age, developmental level
      • sex, gender identity
      • baseline assessment data
      • physiologic status
      • response to medication and interventions
      • psychosocial status, social determinants of health
      • barriers to accessing care and services
      • health literacy
      • cultural and spiritual preferences
      • safety risks
      • family interaction
      • plan for transition of care

    Sepsis or Septic Shock

    Associated Documentation

    • Sepsis/Septic Shock Management

    Presentation

    • chills, rigors
    • hypotension
    • level of consciousness altered
    • mental status altered
    • peripheral perfusion altered
    • tachycardia
    • tachypnea
    • temperature variation (increased or decreased)

    Associated Signs/Symptoms

    • abdominal distension
    • anorexia
    • arthralgia, myalgia
    • cough
    • cyanosis
    • diaphoresis
    • diarrhea
    • dysuria
    • edema
    • fatigue
    • nuchal rigidity
    • pain
    • pallor
    • petechiae, purpura
    • rash
    • shortness of breath
    • urinary frequency
    • urine output decreased
    • vomiting
    • work of breathing increased

    Potential Causes

    • bone or joint infection
    • endocarditis
    • chemotherapy-induced neutropenia
    • implanted device infection
    • intra-abdominal infection
    • meningitis
    • respiratory infection, pneumonia
    • skin or soft tissue infection
    • urinary tract infection
    • wound infection

    Initial Assessment

    • airway patency
    • cardiovascular status
    • fluid status
    • gastrointestinal status
    • musculoskeletal status
    • neurologic status
    • pain evaluation
    • respiratory status
    • skin and soft tissue status

    History

    • allergies
    • comorbidities (acute or chronic)
    • immunization status
    • last menstrual period (females of child bearing age)
    • medications
    • hospitalizations
    • recent antimicrobial therapy
    • recent childbirth
    • recent infection or exposure
    • recent injury or trauma
    • recent procedure or surgery
    • recent travel
    • symptom onset

    Laboratory Studies

    • ABG (arterial blood gas)
    • albumin, prealbumin
    • amylase
    • blood glucose level
    • BUN (blood urea nitrogen)
    • CBC (complete blood count) with differential
    • cerebrospinal fluid analysis
    • coagulation studies
    • CRP (C-reactive protein)
    • cultures and gram stain
    • lipase
    • liver function tests
    • procalcitonin level
    • serum creatinine
    • serum electrolytes
    • serum lactate
    • urinalysis

    Diagnostics

    • ECG (electrocardiogram)
    • x-ray (abdomen, chest)

    Potential Additional Testing

    • CT (computed tomography) scan
    • lumbar puncture
    • MRI (magnetic resonance imaging)
    • pregnancy test (females of childbearing age)
    • radiographic studies for joint pain
    • ultrasound (abdomen, chest)

    Problem Intervention

    Provide Respiratory Support

    • Assess and monitor airway and breathing for effective oxygenation and ventilation; maintain close surveillance for deterioration.
    • Maintain open and patent airway with use of positioning, airway adjuncts and secretion clearance.
    • Position to minimize the risk of aspiration, ventilation-perfusion mismatch and breathlessness.
    • Minimize oxygen consumption and demand; limit activity, reduce fever and utilize breathing techniques.
    • Provide oxygen therapy judiciously; titrate to prevent hyperoxemia; adjust to achieve oxygenation goal.
    • Consider positive pressure ventilation to support oxygenation, ventilation and relieve respiratory distress.
    • Recognize the need for intubation for airway protection and respiratory support; utilize lung protective strategy.

    Problem Intervention

    Provide Hemodynamic Support

    • Provide prompt fluid therapy to improve blood flow, perfusion and tissue oxygenation.
    • Evaluate and address responsiveness to fluid resuscitation during and following each bolus; include blood pressure, peripheral perfusion, breath sounds, mentation and level of consciousness and urine output.
    • Monitor for fluid overload.
    • Anticipate administration of albumin when a large amount of intravascular fluids is needed for resuscitation.
    • Anticipate use of vasoactive agent to support microperfusion and oxygen delivery; titrate to response.
    • Monitor cardiovascular status; observe for, and address, cardiac dysrhythmia.
    • Monitor and manage electrolyte imbalances; monitor other laboratory value trends, such as lactate.
    • Monitor and address end-organ dysfunction; consider using a standardized tool to assess for organ failure.
    • Prepare for supportive therapy, such as corticosteroid therapy, coagulopathy management and urgent intervention in the presence of hemodynamic instability.

    Problem Intervention

    Minimize and Manage Infection

    • Anticipate antimicrobial therapy administration; do not delay in the presence of high suspicion or clinical indicators.
    • Obtain cultures prior to initiating antimicrobial therapy when possible.
    • Determine and address underlying source of infection aggressively; consider vascular access device, invasive devices, meningitis, pneumonia or wound.
    • Initiate precautions to prevent the spread of infection.
    • Monitor blood glucose level and maintain glycemic control.

    Problem Intervention

    Promote Comfort and Manage Pain

    • Use a consistent pain assessment tool; include assessment of functional ability.
    • Evaluate pain and treatment response at regular intervals.
    • Involve patient and family/caregiver in the management plan.
    • Provide nonpharmacologic strategies, such as positioning, quiet and calm environment, as well as minimal stimulation.
    • Consider multimodal pharmacologic measures, such as an analgesic, antipyretic or antianxiety agent.
    • Evaluate risk for opioid use and dependence.

    Problem Intervention

    Facilitate Procedures

    • Evaluate need for NPO (nothing by mouth) status.
    • Prepare for, or assist with, procedure, such as urinary catheter placement, gastric decompression, lumbar puncture, cultures, debridement, incision and drainage, thoracentesis or thoracostomy.
    • Anticipate and prepare for surgical intervention.

    Problem Intervention

    Provide Psychosocial Support

    • Proactively provide information; encourage questions and address concerns.
    • Provide calm, reassuring presence. Monitor for increasing anxiety.
    • Recognize, identify and allow expression of emotions.
    • Promote family/caregiver presence at bedside.
    • Offer choices to enhance a sense of control.
    • Honor spiritual and cultural preferences.
    • Recognize and utilize personal coping strategies.
    • Consider conversation around goals of care; involve palliative care team, if available.

    Problem Intervention

    Initiate Consult or Referral

    • Facilitate consult, such as surgeon, intensivist or infectious disease specialist.
    • Coordinate transition, such as hospital admission, facility transfer or home follow-up.

    Education

    General Emergency Education

    Teaching Focus

    • symptom/problem overview

    • risk factors/triggers

    • self-management

    • assistive device

    • diagnostic test

    • diet modification

    • medical device/equipment use

    • medication administration

    • opioid medication management

    • orthopaedic device

    • safe medication disposal

    • smoking cessation

    • wound care

    Population-Specific Considerations

    Forensics and Legal

    • Utilize local, state/province, federal requirements and hospital policy and protocols to manage patient care involving forensics, protective services, workman’s compensation and mandatory reportable events and illness.

    Human Trafficking

    • Human trafficking victims most frequently seek healthcare services from Emergency Departments. Healthcare professionals, alert to signs of trafficking, can guide supportive care for victims.
    • Trafficked individuals may be male or female and engaged in sex work or other forced labor. High-risk signs requiring more direct questioning about exploitation include, among others, current employment in a high-risk industry, prior sexually transmitted infections, recent immigration, undocumented immigrant status and other vulnerable and minority populations.

    Geriatric

    • Two-thirds of all sepsis cases occur in people 65 years of age and older.
    • This population does not always display physiologic symptoms, such as tachycardia or fever, making identification of sepsis difficult.
    • Older adults require more frequent reassessments to prevent fluid overload.

    Pregnancy

    • Beyond 20 weeks gestation, supine position should be avoided. Patient position should be lateral or lateral tilt to prevent compression of the inferior vena cava and aorta by the pregnant uterus.
    • Patient stabilization is a priority, as fetal status is impacted by patient status.
    • A secondary assessment should include fetal heart rate, contraction activity, presence of vaginal bleeding and membrane status.
    • Normal physiologic changes during pregnancy should be considered when treating a pregnant patient with sepsis. Hemodynamic parameters should be carefully monitored.
    • Infection during pregnancy can result in the increased production of prostaglandins, which may lead to preterm labor.

    Quality Measures

    • NQF 0495. Median Time from ED arrival to ED Departure for Admitted ED Patients
      Median time from emergency department arrival to time of departure from the emergency room for patients admitted to the facility from the emergency department.
      Steward: Centers for Medicare and Medicaid Services
      Care Setting: ED, Hospital
      National Quality Forum-endorsed measure
      Last Edited: 10/11/2017
    • NQF 0496. Median Time from ED arrival to ED Departure for Discharged ED Patients
      Median time from emergency department arrival to time of departure from the emergency room for patients discharged from the emergency department.
      Steward: Centers for Medicare and Medicaid Services
      Care Setting: ED, Hospital
      National Quality Forum-endorsed measure
      Last Edited: 10/11/2017

    References

    • (2018). Heuer, A. J.; Scanlan, C. L. (Eds.), Wilkins' Clinical Assessment in Respiratory Care. St. Louis: Elsevier. [Core Curriculum]
    • (2021). Kacmarek, R. M.; Stoller, J. K.; Heuer, A. J. (Eds.), Egan's Fundamentals of Respiratory Care. St. Louis: Elsevier. [Core Curriculum]
    • Alhazzani, W.; Evans, L.; Alshamsi, F.; Møller, M.H.; Ostermann, M.; et al. Surviving sepsis campaign guidelines on the management of adults with coronavirus disease 2019 (COVID-19) in the ICU: First update. Critical Care Medicine. 2021;49(3), e219-e234. doi:10.1097/CCM.0000000000004899 [Expert/Committee Opinion,Clinical Practice Guidelines]
    • American College of Emergency Physicians. Geriatric emergency department guidelines. Annals of Emergency Medicine. 2014;63(5), e7-e25. doi:10.1016/j.annemergmed.2014.02.008 Source[Quality Measures,Clinical Practice Guidelines]
    • Andriolo, B. N. G.; Andriolo, R. B.; Salomão, R.; Atallah, Á. N. Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock. Cochrane Database of Systematic Reviews. 2017;(1) doi:10.1002/14651858.CD010959.pub2 [Metasynthesis,Meta-analysis,Systematic Review]
    • Annane, D.; Bellissant, E.; Bollaert, P. E.; Briegel, J.; Keh, D.; Kupfer, Y. Corticosteroids for treating sepsis. Cochrane Database of Systematic Reviews. 2015;(12) doi:10.1002/14651858.CD002243.pub3 [Metasynthesis,Meta-analysis,Systematic Review]
    • Annane, D.; Bellissant, E.; Bollaert, P. E.; Briegel, J.; Keh, D.; Kupfer, Y. Corticosteroids for treating sepsis. Cochrane Database of Systematic Reviews. 2015;(12) doi:10.1002/14651858.CD002243.pub3 [Metasynthesis,Meta-analysis,Systematic Review]
    • Armstrong, B. A.; Betzold, R. D.; May, A. K.. Sepsis and septic shock strategies. Surgical Clinics of North America. 2017;97(6), 1339-1379. doi:10.1016/j.suc.2017.07.003 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Bader, M. K.; Littlejohns, L. R.; Olson, D. M. (2016). AANN Core curriculum for neuroscience nursing. Chicago: American Association of Neuroscience Nurses. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Barbateskovic, M.; Schjørring, O. L.; Russo Krauss, S.; Meyhoff, C. S.; Jakobsen, J. C.; Rasmussen, B. S.; Perner, A.; Wetterslev, J. Higher vs Lower Oxygenation Strategies in Acutely Ill Adults: A Systematic Review With Meta-Analysis and Trial Sequential Analysis. Chest. 2021, Jan;159(1), 154-173. doi:10.1016/j.chest.2020.07.015 Source[Meta-analysis,Systematic Review]
    • Barlow, A.; Barlow, B.; Tang, N.; Shah, B. M.; King, A. E. Intravenous fluid management in critically ill adults: A review. Critical Care Nurse. 2020;40(6), e17-e27. doi:10.4037/ccn2020337 [Review Articles]
    • Berning, M. J.; e Silva, L. O. J.; Suarez, N. E.; Walker, L. E.; Erwin, P.; Carpenter, C. R.; Bellolio, F. Interventions to improve older adults' Emergency Department patient experience: A systematic review. The American Journal of Emergency Medicine. 2020;38(6), 1257-1269. doi:10.1016/j.ajem.2020.03.012 Source[Systematic Review]
    • Centers for Medicare & Medicaid Services (CMS). (2017). NQF 0495. Median Time from ED Arrival to ED Departure for Admitted ED Patients. Source[Quality Measures,Clinical Practice Guidelines]
    • Centers for Medicare & Medicaid Services (CMS). (2017). NQF 0496. Median time from ED arrival to ED departure for discharged ED patients. Source[Quality Measures,Clinical Practice Guidelines]
    • Chen, X.; Zhu, W.; Tan, J.; Nie, H.; Liu, L.; Yan, D.; Zhou, X.; Sun, X.. Early outcome of early-goal directed therapy for patients with sepsis or septic shock: A systematic review and meta-analysis of randomized controlled trials. Oncotarget. 2017;8(16), 27510-27519. doi:10.18632/oncotarget.15550 [Metasynthesis,Meta-analysis,Systematic Review]
    • Chou, R.; Wagner, J.; Ahmed, A. Y.; Blazina, I.; Brodt, E.; Buckley, D. I.; Cheney, T. P.; Choo, E.; Dana, T.; Gordon, D.; Khandelwal, S.; Kantner, S.; McDonagh, M. S.; Sedgley, C.; Skelly, A. C. Treatments for Acute Pain: A Systematic Review. Comparative Effectiveness Review No. 240. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2015-00009-I.) AHRQ Publication No. 20(21)-EHC006. 2020, Dec;doi:10.23970/AHRQEPCCER240 Source[Systematic Review]
    • Claesson, J.; Freundlich, M.; Gunnarsson, I.; Laake, J. H.; Vandvik, P. O.; Varpula, T.; Aasmundstad, T. A. Scandinavian clinical practice guideline on mechanical ventilation in adults with the acute respiratory distress syndrome. Acta Anaesthesiologica Scandinavica. 2015;59, 286-297. doi:10.1111/aas.12449 [Quality Measures,Clinical Practice Guidelines]
    • Davidson, A. C.;Banham, S.; Elliott, M.; Kennedy, D.; Gelder, C.; Glossop, A.; Church, A. C.; Creagh-Brown, J. W. D.; Felton, T.; Foëx, B.; Mansfield, L.; McDonnell, L.; Parker, R.; Patterson, C. M.; Sovani, M.; Thomas, L.. BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Thorax. 2016;71(Suppl 2), ii1-ii35. [Quality Measures,Clinical Practice Guidelines]
    • Davis, M. D.; Walsh, B. K.; Sittig, S. E.;Restrepo, R. D.. AARC clinical practice guideline: Blood gas analysis and hemoximetry. Respiratory Care. 2013;58(10), 1694-1703. [Quality Measures,Clinical Practice Guidelines]
    • Dellinger, R. P.; Schorr, C. A.; Levy, M. M. A users’ guide to the 2016 surviving sepsis guidelines. Intensive care medicine. Intensive Care Medicine. 2017;43(3), 299-303. doi:10.1007/s00134-017-4681-8 [Expert/Committee Opinion]
    • Dellinger, R. P.; Schorr, C. A.; Levy, M. M. A users’ guide to the 2016 surviving sepsis guidelines. Intensive care medicine. Intensive Care Medicine. 2017;43(3), 299-303. doi:10.1007/s00134-017-4681-8 [Expert/Committee Opinion]
    • Dellinger, R. P.; Schorr, C. A.; Levy, M. M. A users’ guide to the 2016 surviving sepsis guidelines. Intensive care medicine. Intensive Care Medicine. 2017;43(3), 299-303. doi:10.1007/s00134-017-4681-8 [Expert/Committee Opinion]
    • DeWitt, S.; Chavez, S. A.; Perkins, J.; Long, B.; Koyfman, A.. Evaluation of fever in the emergency department. American Journal of Emergency Medicine. 2017;35(11), 1755-1758. doi:10.1016/j.ajem.2017.08.030 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • DeWitt, S.; Chavez, S. A.; Perkins, J.; Long, B.; Koyfman, A.. Evaluation of fever in the emergency department. American Journal of Emergency Medicine. 2017;35(11), 1755-1758. doi:10.1016/j.ajem.2017.08.030 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Elwan, M. H.; Roshdy, A.;Elsharkawy, E. M.; Eltahan, S. M.; Coats, T. J.. The haemodynamic dilemma in emergency care: Is fluid responsiveness the answer? A systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2017;25(1), 25. doi:10.1186/s13049-017-0370-4 [Metasynthesis,Meta-analysis,Systematic Review]
    • Emergency Nurses Association. (2018). Emergency nursing core curriculum. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Emergency Nurses Association. (2018). Emergency nursing core curriculum. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Emergency Nurses Association. (2018). Emergency nursing core curriculum. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Emergency Nurses Association. (2018). Emergency nursing core curriculum. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Emergency Nurses Association. (2018). Emergency nursing core curriculum. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Emergency Nurses Association. (2018). Emergency nursing core curriculum. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Emergency Nurses Association. (2018). Emergency nursing core curriculum. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Emergency Nurses Association. (2020). Sweet, V.; Foley, A (Eds.), Sheehy's Emergency Nursing Principles and Practice. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Emergency Nurses Association. (2020). Sweet, V.; Foley, A (Eds.), Sheehy's Emergency Nursing Principles and Practice. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Epstein, E.; McDougall, M.; Thomas, P.. Intravenous fluids in hospital: Practical approaches. British Journal of Hospital Medicine. 2017;78(4), C50-C54. doi:10.12968/hmed.2017.78.4.C50 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Evans, L.; Rhodes, A.; Alhazzani, W.; Antonelli, M.; Coopersmith, C. M.; et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Medicine. 2021; doi:10.1007/s00134-021-06506-y Source[Clinical Practice Guidelines]
    • Evans, L.; Rhodes, A.; Alhazzani, W.; Antonelli, M.; Coopersmith, C. M.; et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Medicine. 2021; doi:10.1007/s00134-021-06506-y Source[Clinical Practice Guidelines]
    • Evans, L.; Rhodes, A.; Alhazzani, W.; Antonelli, M.; Coopersmith, C. M.; et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Medicine. 2021; doi:10.1007/s00134-021-06506-y Source[Clinical Practice Guidelines]
    • Evans, L.; Rhodes, A.; Alhazzani, W.; Antonelli, M.; Coopersmith, C. M.; et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Medicine. 2021; doi:10.1007/s00134-021-06506-y Source[Clinical Practice Guidelines]
    • Evans, L.; Rhodes, A.; Alhazzani, W.; Antonelli, M.; Coopersmith, C. M.; et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Medicine. 2021; doi:10.1007/s00134-021-06506-y Source[Clinical Practice Guidelines]
    • Fan, E.; Del Sorbo, L.; Goligher, E. C.; Hodgson, C. L.; Munshi, L.; Walkey, A. J.; Adhikari. N. K. J.; Amato, M. B. P.; Branson, R.; Brower, R. G.; Ferguson, N. D.; Gajic, O.; Gattinoni, L.; Hess, D.; Mancebo, J.; Meade, M. O.; McAuley, D. F.; Pesenti, A.; Ranieri, V. M.; Rubenfeld, G. D.; Rubin, E.; Seckel, M.; Slutsky, A. S.; Talmor, D.; Thompson, B. T.; Wunsch, H.; Uleryk, E.; Brozek, J.; Brochard, L. J.; American Thoracic Society; European Society of Intensive Care Medicine; Society of Critical Care Medicine. An official american thoracic Society/European society of intensive care Medicine/Society of critical care medicine clinical practice guideline: Mechanical ventilation in adult patients with acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine. 2017;195(9), 1253-1263. doi:10.1164/rccm.201703-0548ST [Quality Measures,Clinical Practice Guidelines]
    • Gavelli, F.; Castello, L. M.; Avanzi, G. C. Management of sepsis and septic shock in the emergency department. Internal and Emergency Medicine. 2021;, 1-13. doi:10.1007/s11739-021-02735-7 [Review Articles]
    • Gavelli, F.; Castello, L. M.; Avanzi, G. C. Management of sepsis and septic shock in the emergency department. Internal and Emergency Medicine. 2021;, 1-13. doi:10.1007/s11739-021-02735-7 [Review Articles]
    • Gavelli, F.; Castello, L. M.; Avanzi, G. C. Management of sepsis and septic shock in the emergency department. Internal and Emergency Medicine. 2021;, 1-13. doi:10.1007/s11739-021-02735-7 [Review Articles]
    • Gibbison, B.; López-López, J. A.; Higgins, J. P.; Miller, T.; Angelini, G. D.; Lightman, S. L.; Annane, D. Corticosteroids in septic shock: A systematic review and network meta-analysis. Critical Care. 2017;21(1), 78. [Metasynthesis,Meta-analysis,Systematic Review]
    • Gibbison, B.; López-López, J. A.; Higgins, J. P.; Miller, T.; Angelini, G. D.; Lightman, S. L.; Annane, D. Corticosteroids in septic shock: A systematic review and network meta-analysis. Critical Care. 2017;21(1), 78. [Metasynthesis,Meta-analysis,Systematic Review]
    • Greenbaum, J.. Identifying victims of human trafficking in the emergency department. Clinical Pediatric Emergency Medicine. 2016;17(4), 241-248. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Gulanick, M.; Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions and outcomes. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Hachimi-Idrissi, S.; Coffey, F.; Hautz, W. E.; Leach, R.; Sauter, T. C.; Sforzi, I.; Dobias, V. Approaching acute pain in emergency settings: European Society for Emergency Medicine (EUSEM) guidelines - part 1: assessment. Internal and Emergency Medicine. 2020;15(7), 1125-1139. doi:10.1007/s11739-020-02477-y Source[Clinical Practice Guidelines]
    • Hachimi-Idrissi, S.; Dobias, V.; Hautz, W. E.; Leach, R.; Sauter, T. C.; Sforzi, I.; Coffey, F. Approaching acute pain in emergency settings: European Society for Emergency Medicine (EUSEM) guidelines - part 2: Management and recommendations. Internal and Emergency Medicine. 2020;15(7), 1141-1155. doi:10.1007/s11739-020-02411-2 Source[Clinical Practice Guidelines]
    • Hafner, S.; Beloncle, F.; Koch, A.; Radermacher, P.; Asfar, P. Hyperoxia in intensive care, emergency, and peri-operative medicine: Dr. Jekyll or Mr. Hyde? A 2015 update. Annals of Intensive Care. 2015;5(1) doi:10.1186/s13613-015-0084-6 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Hamilton, F.; Arnold, D.; Baird, A.; Albur, M.; Whiting, P.. Early warning scores do not accurately predict mortality in sepsis: A meta-analysis and systematic review of the literature. Journal of Infection. 2018;76(3), 241-248. doi:10.1016/j.jinf.2018.01.002 [Quality Measures,Clinical Practice Guidelines]
    • Hashimoto, S.; Sanui, M.; Egi, M.; Ohshimo, S.; Shiotsuka, J.; Seo, R.; Tanaka, R.; Tanaka, Y.; Norisue, Y.; Hayashi, Y.; Nango, E.; ARDS Clinical Practice Guideline Committee from the Japanese Society of Respiratory Care Medicine; Japanese Society of Intensive Care Medicine. The clinical practice guideline for the management of ARDS in Japan. Journal of Intensive Care. 2017;5, 50. doi:10.1186/s40560-017-0222-3 [Quality Measures,Clinical Practice Guidelines]
    • Helmerhorst, H. J.; Roos-Blom, M. J.; van Westerloo, D. J.; de Jonge, E. Association between arterial hyperoxia and outcome in subsets of critical illness:  A systematic review, meta-analysis, and meta-regression of cohort studies. Critical Care Medicine. 2015;43(7), 1508-1519. doi:10.1097/CCM.0000000000000998 [Metasynthesis,Meta-analysis,Systematic Review]
    • Johnston, A. N. B.; Park, J.; Doi, S. A.; Sharman, V.; Clark, J.; Robinson, J.; Crilly, J.. Effect of immediate administration of antibiotics in patients with sepsis in tertiary care: A systematic review and meta-analysis. Clinical Therapeutics. 2017;39(1), 190-202.e6. doi:10.1016/j.clinthera.2016.12.003 Source[Metasynthesis,Meta-analysis,Systematic Review]
    • Johnston, A. N. B.; Park, J.; Doi, S. A.; Sharman, V.; Clark, J.; Robinson, J.; Crilly, J.. Effect of immediate administration of antibiotics in patients with sepsis in tertiary care: A systematic review and meta-analysis. Clinical Therapeutics. 2017;39(1), 190-202.e6. doi:10.1016/j.clinthera.2016.12.003 Source[Metasynthesis,Meta-analysis,Systematic Review]
    • Kabil, G.; Hatcher, D.; Alexandrou, E.; McNally, S.. Emergency nurses’ experiences of the implementation of early goal directed fluid resuscitation therapy in the management of sepsis: a qualitative study. Australasian Emergency Care. 2021;24(1), 67-72. doi:10.1016/j.auec.2020.07.002 [Expert/Committee Opinion]
    • Khoujah, D.; Martinelli, A. N.; Winters, M. E. Resuscitating the Critically Ill Geriatric Emergency Department Patient. Emergency Medicine Clinics of North America. 2019;37(3), 569-581. doi:10.1016/j.emc.2019.04.002 [Review Articles]
    • Laher, A. E.;Watermeyer, M. J.;Buchanan, S. K.;Dippenaar, N.;Simo, N. C. T.;Motara, F.;Moolla, M.. A review of hemodynamic monitoring techniques, methods and devices for the emergency physician. American Journal of Emergency Medicine. 2017;35(9), 1335-1347. doi:10.1016/j.ajem.2017.03.036 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Levy, M. M.; Evans, L. E.; Rhodes, A.. The surviving sepsis campaign bundle: 2018 update. Critical Care Medicine. 2018;46(6), 997-1000. doi:10.1097/CCM.0000000000003119 [Quality Measures,Clinical Practice Guidelines]
    • Liang, S. Y.. Sepsis and other infectious disease emergencies in the elderly. Emergency Medicine Clinics of North America. 2016;34(3), 501-522. doi:10.1016/j.emc.2016.04.005 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Long, B.; Koyfman, A.. Best clinical practice: Blood culture utility in the emergency department. Journal of Emergency Medicine. 2016;51(5), 529-539. doi:10.1016/j.jemermed.2016.07.003 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Malbrain, M. L. N. G.; Langer, T.; Annane, D.; Gattinoni, L.; Elbers, P.; Hahn, R. G.; De Laet, I.; Minini, A.; Wong, A.; Ince, C.; Muckart, D.; Mythen, M.; Caironi, P.; Van Regenmortel, N. Intravenous fluid therapy in the perioperative and critical care setting: Executive summary of the International Fluid Academy (IFA). Annals of Intensive Care. 2020, May;10(1), 64. doi:10.1186/s13613-020-00679-3 [Expert/Committee Opinion]
    • Marx, J. A.; Hockberger, R. S.; Walls, R. M. (2018). Rosen's emergency medicine. Philadelphia: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Marx, J. A.; Hockberger, R. S.; Walls, R. M. (2018). Rosen's emergency medicine. Philadelphia: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Motov, S.; Strayer, R.; Hayes, B. D.; Reiter, M.; Rosenbaum, S.; Richman, M.; Repanshek, Z.; Taylor, S.; Friedman, B.; Vilke, G.; Lasoff, D. The treatment of acute pain in the emergency department: a white paper position statement prepared for the American Academy of Emergency Medicine. The Journal of Emergency Medicine. 2018;54(5), 731-736. doi:10.1016/j.jemermed.2018.01.020 Source[Expert/Committee Opinion,Position Statements]
    • National Institute for Health and Care Excellence. (2013 [Updated 2017]). Intravenous fluid therapy in adults in hospital . Source[Quality Measures,Clinical Practice Guidelines]
    • National Institute for Health and Care Excellence. (2016). Sepsis: Recognition, diagnosis and early management. (NICE guideline [NG51]). Source[Quality Measures,Clinical Practice Guidelines]
    • National Institute for Health and Care Excellence. (2016). Sepsis: Recognition, diagnosis and early management. (NICE guideline [NG51]). Source[Quality Measures,Clinical Practice Guidelines]
    • National Institute for Health and Care Excellence. (2016). Sepsis: Recognition, diagnosis and early management. (NICE guideline [NG51]). Source[Quality Measures,Clinical Practice Guidelines]
    • National Institute for Health and Care Excellence. (2016). Sepsis: Recognition, diagnosis and early management. (NICE guideline [NG51]). Source[Quality Measures,Clinical Practice Guidelines]
    • Ni, Y. N.; Wang, Y. M.; Liang, B. M.; Liang, Z. A. The effect of hyperoxia on mortality in critically ill patients: A systematic review and meta anaysis. BMC Pulmonary Medicine. 2019;19(1), 53. [Metasynthesis,Meta-analysis,Systematic Review]
    • Nishida, O.; Ogura, H.; Egi, M.; Fujishima, S.; Hayashi, Y.; Iba, T.; Imaizumi, H.; Inoue, S.; Kakihana, Y.; Kotani, J.; Kushimoto, S.; Masuda, Y.; Matsuda, N.; Matsushima, A.; Nakada, T. A.; Nakagawa, S.; Nunomiya, S.; Sadahiro, T.; Shime, N.; Yatabe, T.; Hara, Y.; Hayashida, K.; Kondo, Y.; Sumi, Y.; Yasuda, H.; Aoyama, K.; Azuhata, T.; Doi, K.; Doi, M.; Fujimura, N.; Fuke, R.; Fukuda, T.; Goto, K.; Hasegawa, R.; Hashimoto, S.; Hatakeyama, J.; Hayakawa, M.; Hifumi, T.; Higashibeppu, N.; Hirai, K.; Hirose, T.; Ide, K.; Kaizuka, Y.; Kan'o, T.; Kawasaki, T.; Kuroda, H.; Matsuda, A.; Matsumoto, S.; Nagae, M.; Onodera, M.; Ohnuma, T.; Oshima, K.; Saito, N.; Sakamoto, S.; Sakuraya, M.; Sasano, M.; Sato, N.; Sawamura, A.; Shimizu, K.; Shirai, K.; Takei, T.; Takeuchi, M.; Takimoto, K.; Taniguchi, T.; Tatsumi, H.; Tsuruta, R.; Yama, N.; Yamakawa, K.; Yamashita, C.; Yamashita, K.; Yoshida, T.; Tanaka, H.; Oda, S. The Japanese clinical practice guidelines for management of sepsis and septic shock 2016 (J-SSCG 2016). Journal of Intensive Care. 2018;6(1), 7. doi:10.1186/s40560-017-0270-8 [Quality Measures,Clinical Practice Guidelines]
    • O'Driscoll, B. R.; Howard, L. S.; Earis, J.; Mak, V.; British Thoracic Society Emergency Oxygen Guideline Group. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017, Jun;72(Suppl 1), ii1-ii90. [Quality Measures,Clinical Practice Guidelines]
    • Panchal, A. R.; Bartos, J. A.; Cabañas, J. G.; Donnino, M. W.; Drennan, I. R.; Hirsch, K. G.; Kudenchuk, P. J.; Kurz, M. C.; Lavonas, E. J.; Morley, P. T.; O'Neil, B. J.; Peberdy, M. A.; Rittenberger, J. C.; Rodriguez, A. J.; Sawyer, K. N.; Berg, K. M. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020, Oct;142(16_Suppl_2), S366-S468. doi:10.1161/CIR.0000000000000916 Source[Quality Measures,Clinical Practice Guidelines]
    • Panchal, A. R.; Bartos, J. A.; Cabañas, J. G.; Donnino, M. W.; Drennan, I. R.; Hirsch, K. G.; Kudenchuk, P. J.; Kurz, M. C.; Lavonas, E. J.; Morley, P. T.; O'Neil, B. J.; Peberdy, M. A.; Rittenberger, J. C.; Rodriguez, A. J.; Sawyer, K. N.; Berg, K. M. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020, Oct;142(16_Suppl_2), S366-S468. doi:10.1161/CIR.0000000000000916 Source[Quality Measures,Clinical Practice Guidelines]
    • Pulia, M. S.; Redwood, R.; Sharp, B.. Antimicrobial stewardship in the management of sepsis. Emergency Medicine Clinics of North America. 2017;35(1), 199-217. doi:10.1016/j.emc.2016.09.007 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Pulia, M. S.; Redwood, R.; Sharp, B.. Antimicrobial stewardship in the management of sepsis. Emergency Medicine Clinics of North America. 2017;35(1), 199-217. doi:10.1016/j.emc.2016.09.007 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Registered Nurses' Association of Ontario. (2015). Person- and family-centred care. Source[Quality Measures,Clinical Practice Guidelines]
    • Ringer, T.; Moller, D.; Mutsaers, A.. Distress in caregivers accompanying patients to an emergency department: A scoping review. Journal of Emergency Medicine. 2017;53(4), 493-508. [Metasynthesis,Meta-analysis,Systematic Review]
    • Rothrock, S. G.; Cassidy, D. D.; Barneck, M.; Schinkel, M.; Guetschow, B.; Myburgh, C.; Nguyen, L.; Earwood, R.; Nanayakkara, P. W. B.; Nannan Panday, R. S.; Briscoe, J. G. Outcome of Immediate Versus Early Antibiotics in Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis. Annals of Emergency Medicine. 2020, Oct;76(4), 427-441. doi:10.1016/j.annemergmed.2020.04.042 Source[Meta-analysis,Systematic Review]
    • Sakamoto, J. T.; Ward, H. B.; Vissoci, J. R. N.; Eucker, S. A. Are nonpharmacologic pain interventions effective at reducing pain in adult patients visiting the emergency department? A systematic review and meta-analysis. Academic Emergency Medicine. 2018;25(8), 940-957. doi:10.1111/acem.13411 Source[Meta-analysis,Systematic Review]
    • Saugel, B.; Huber, W.; Nierhaus, A.; Kluge, S.; Reuter, D. A.; Wagner, J. Y.. Advanced hemodynamic management in patients with septic shock. BioMed Research International. 2016;2016 doi:10.1155/2016/8268569 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Schug, S. A.; Palmer, G. M.; Scott, D. A.; Halliwell, R.; Trinca, J.; APM: SE Working Group of the Australian and New Zealand College of Anaesthetists; Faculty of Pain Medicine. (2015). Acute pain management: Scientific evidence. Melbourne, Australia: Australian and New Zealand College of Anaesthetists; Faculty of Pain Medicine. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Siddiqui, S.; Razzak, J.. Early versus late pre-intensive care unit admission broad spectrum antibiotics for severe sepsis in adults. Cochrane Database of Systematic Reviews. 2010;(10) doi:10.1002/14651858.CD007081.pub2 [Metasynthesis,Meta-analysis,Systematic Review]
    • Siegel, J. D.; Rhinehart, E.; Jackson, M.; Chiarello, L.; Healthcare Infection Control Practices Advisory Committee. Guideline for isolation precautions:  Preventing transmission of infectious agents in healthcare settings. American Journal of Infection Control. 2007, June;35, S64-S164. [Quality Measures,Clinical Practice Guidelines]
    • Siemieniuk, R. A.; Chu, D. K.; Kim L. H. Y.; Güell-Rous, M. R.; Alhazzani, W.; Soccal, P. M.; Karanicolas, P. J.; Farhournand, P. D.; Siemieniuk, J. L. K.; Satia, I.; Irusen, E. M.; Refaat, M. M.; Mikita, J. S.; Smith, M.; Cohen, D. N.; Vandvik, P. O.; Agoritsas, T.; Lytvyn, L.; Guyatt, G.. Oxygen therapy for acutely ill medical patients: A clinical practice guideline. BMJ. 2018;363, k4169. doi:10.1136/bmj.k4169 Source[Quality Measures,Clinical Practice Guidelines]
    • Silversides, J. A.; Major, E.; Ferguson, A. J.; Mann, E. E.; McAuley, D. F.; Marshall, J. C.; Blackwood, B.; Fan, E. Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: A systematic review and meta-analysis. Intensive Care Medicine. 2017, February;43(2), 155-170. doi:10.1007/s00134-016-4573-3 [Metasynthesis,Meta-analysis,Systematic Review]
    • Singer, M.; Deutschman, C. S.; Seymour, C. W.; Shankar-Hari, M.; Annane, D.; Bauer, M.; Bellomo, R.; Bernard, G. R.; Chiche, J. D.; Coopersmith, C. M.; Hotchkiss, R. S.; Levy, M. M.; Marshall, J. C.; Martin, G. S.; Opal, S. M.; Rubenfeld, G. D.; van der Poll, T.; Vincent, J. L.; Angus, D. C.. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8), 801-810. doi:10.1001/jama.2016.0287 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Society of Critical Care Medicine (SCCM). Surviving Sepsis Campaign (Adult). Source[Policy/Practice Standards]
    • Society of Critical Care Medicine (SCCM). Surviving Sepsis Campaign (Adult). Source[Policy/Practice Standards]
    • Troiano, N. H.; Witcher, P. M.; McMurtry Baird, S.. (2019). AWHONN: High-risk & critical care obstetrics. Philadelphia: Wolters Kluwer. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • U. S. Department of Health and Human Services. (2017). Human trafficking webinar for health care providers: SOAR to health and wellness. Source[Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • van der Does, Y.; Rood, P. P.; Haagsma, J. A.; Patka, P.; van Gorp, E. C.; Limper, M.. Procalcitonin-guided therapy for the initiation of antibiotics in the ED: A systematic review. American Journal of Emergency Medicine. 2016;34(7), 1286-1293. doi:10.1016/j.ajem.2016.03.065 [Quality Measures,Clinical Practice Guidelines]
    • Wang, D. H.. Beyond code status: Palliative care begins in the emergency department. Annals of Emergency Medicine. 2017;69(4), 437-443. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Wensley, C.; Botti, M.; Mckillop, A.; Merry, A. F.. A framework of comfort for practice: An integrative review identifying the multiple influences on patients' experience of comfort in healthcare settings. International Journal of Quality in Health Care. 2017;29(2), 151-162. doi:10.1093/intqhc/mzw158 Source[Metasynthesis,Meta-analysis,Systematic Review]
    • Wolf, L.; Storer, A.; Barnason, S.; Brim, C.; Halpern, J.; Leviner, S.; Lindauer, C.; Patrick, V. C.; Proehl, J. A.; Williams, J.; Bradford, J. Y. (2012). Clinical practice guideline: Family presence during invasive procedures and resuscitation. United States: Emergency Nurses Association. [Quality Measures,Clinical Practice Guidelines]
    • Xantus, G. Z.; Allen, P.; Norman, S.; Kanizsai, P. L. Mortality benefit of crystalloids administered in 1–6 hours in septic adults in the ED systematic review with narrative synthesis. Emergency Medicine Journal. 2021; doi:10.1136/emermed-2020-210298 [Systematic Review]
    • Xantus, G. Z.; Allen, P.; Norman, S.; Kanizsai, P. L. Mortality benefit of crystalloids administered in 1–6 hours in septic adults in the ED systematic review with narrative synthesis. Emergency Medicine Journal. 2021; doi:10.1136/emermed-2020-210298 [Systematic Review]
    • Xantus, G.; Allen, P.; Norman, S.; Kanizsai, P. Antibiotics administered within 1 hour to adult emergency department patients screened positive for sepsis: a systematic review. European Journal of Emergency Medicine. 2020;27(4), 260-267. doi:10.1097/MEJ.0000000000000654 [Systematic Review]
    • Xantus, G.; Allen, P.; Norman, S.; Kanizsai, P. Antibiotics administered within 1 hour to adult emergency department patients screened positive for sepsis: a systematic review. European Journal of Emergency Medicine. 2020;27(4), 260-267. doi:10.1097/MEJ.0000000000000654 [Systematic Review]

    Disclaimer

    Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.

    ;