Tamingthesru
Lessons in Transport - Surviving Sepsis Part 2
"Around every 3rd heartbeat someone dies of sepsis"
Blood Product Administration:
- Once tissue hypoperfusion has resolved and in the absence of extenuating circumstances, such as myocardial ischemia, severe hypoxemia, acute hemorrhage, or ischemic heart disease, we recommend that red blood cell transfusion occur only when hemoglobin concentration has decreased to < 7.0 g/dL to target a hemoglobin concentration of 7.0-9.0 g/dL in adults (grade 1B).
- FFP NOT be used to correct laboratory clotting abnormalities in the absence of bleeding or planned invasive procedures (grade 2D).
Lessons in Transport - Surviving Sepsis
We routinely transport patients with severe sepsis and septic shock by both air and ground. Take a few moments to review these high yield management pearls from the 3rd edition of the Surviving Sepsis Campaign Guidelines.
Initial Resuscitation:
- Goals during the first 6 hours of resuscitation:
- CVP 8-12 mmHg (a debate on the utility of CVP or lack their of is beyond the scope of this LIT)
- MAP > 65 mmHg
- Urine output > 0.5ml/kg/hr
- Central venous or mixed venous oxygen saturation 70% or 65% respectively (grade 1c)
- In patients with elevated lacate levels we should target resuscitation to normalize lactate (grade 2c)
Multiple Helicopter Scenes
It is not uncommon for multiple helicopters to land on the scene of a multi-car accident or a single vehicle accident with multiple seriously injured victims. Assessing, caring for, and transporting multiple victims adds a significant amount of complexity to these scene flights. With multiple helicopters flying in, it is especially crucial that we heed all the lessons of crew resource management. Situational awareness both in the air and on the ground is key. But the challenges of multiple helicopter scenes are not limited only to safety considerations.