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Severe sepsis and septic shock are common problems in the emergency department patient population and require expert clinical skill by members of the emergency department team to maximize optimal patient outcomes. Although various guidelines have been developed for the management of these patients, issues around antimicrobial-related considerations in critically ill patients require further evidence-based attention. In this review article, important factors related to patient illness, microorganism, timing of antimicrobial administration, and source control are discussed., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Introduction: Optimal management of severe sepsis in the ED has evolved rapidly. The purpose of these guidelines is to review key management principles for Canadian emergency physicians, utilizing an evidence-based grading system., Methods: Key areas in the management of septic patents were determined by members of the CAEP Critical Care Interest Group (C4). Members of C4 were assigned a question to be answered after literature review, based on the Oxford grading system. After completion, each section underwent a secondary review by another member of C4. A tertiary review was conducted by additional external experts, and modifications were determined by consensus. Grading was based on peer-reviewed publications only, and where evidence was insufficient to address an important topic, a "practice point" was provided based on group opinion., Results: The project was initiated in 2005 and completed in December 2007. Key areas which were reviewed include the definition of sepsis, the use of invasive procedures, fluid resuscitation, vasopressor/inotrope use, the importance of culture acquisitionin the ED, antimicrobial therapy and source control. Other areas reviewed included the use of corticosteroids, activated protein C, transfusions and mechanical ventilation., Conclusion: Early sepsis management in the ED is paramount for optimal patient outcomes. The CAEP Critical Care Interest Group Sepsis Position Statement provides a framework to improve the ED care of this patient population.

Background. Patients with sepsis benefit from early diagnosis and treatment. Accurate paramedic recognition of sepsis is important to initiate care promptly for patients who arrive by Emergency Medical Services. Methods. Prospective observational study of adult patients (age ≥ 16 years) transported by paramedics to the emergency department (ED) of a Canadian tertiary hospital. Paramedic identification of sepsis was assessed using a novel prehospital sepsis screening tool developed by the study team and compared to blind, independent documentation of ED diagnoses by attending emergency physicians (EPs). Specificity, sensitivity, accuracy, positive and negative predictive value, and likelihood ratios were calculated with 95% confidence intervals. Results. Overall, 629 patients were included in the analysis. Sepsis was identified by paramedics in 170 (27.0%) patients and by EPs in 71 (11.3%) patients. Sensitivity of paramedic sepsis identification compared to EP diagnosis was 73.2% (95% CI 61.4–83.0), while specificity was 78.8% (95% CI 75.2–82.2). The accuracy of paramedic identification of sepsis was 78.2% (492/629, 52 true positive, 440 true negative). Positive and negative predictive values were 30.6% (95% CI 23.8–38.1) and 95.9% (95% CI 93.6–97.5), respectively. Conclusion. Using a novel prehospital sepsis screening tool, paramedic recognition of sepsis had greater specificity than sensitivity with reasonable accuracy. [ABSTRACT FROM AUTHOR]

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The article presents study on the efficacy and safety of low-dose hydrocortisone therapy among patients with septic shock and the use of corticotrophin testing in the U.S. emergency department. Study suggests that shock reversal occurred at similar rates among the patients that received hydrocortisone. The prevalence of other adverse events such as polyneuropathy is also significant. It recommends that steroids should be administered to septic patients who remain hypotensive.

The article focuses on the study concerning the effect of pentastarch resuscitation in treating patients with severe sepsis and septic shock. It says that patients with severe sepsis or septic shock who were administered with pentastarch experienced renal failure. It suggests that emergency physicians should avoid the use of hydroxyethyl starch (HES) to their patients with severe sepsis or septic shock to avoid the possibility to have complications in kidney.

The article discusses management of severe sepsis and septic shock after the withdrawal of Xigris. Sever sepsis is an inflammation caused by infection and since its pathophysiology is complex, promising medications thought to be of potential benefit have not translated into clinical utility. Use of Xigris had indicated a significant anti-inflammatory effect and a possible improvement but trial data indicated lack of benefit and possibility of harm and therefore it was withdrawn from the market.