Management of sepsis and septic shock in the emergency department

Gavelli, Francesco; Castello, Luigi Mario; Avanzi, Gian Carlo

doi:10.1007/s11739-021-02735-7

Cited by 79 publications

(66 citation statements)

References 112 publications

(180 reference statements)

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“…Certain medical emergencies present a marked clinical manifestation, e.g., trauma, myocardial infarction, or stroke; all of them have specific codes and action guidelines already implemented to help in the management of these pathophysiological conditions [ 2 ] [ 3 ] [ 4 ]. However, other syndromic conditions such as sepsis present a more diffuse manifestation that may sometimes be unnoticed in its initial stages [ 5 ] [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Combination of Prehospital NT-proBNP with qSOFA and NEWS to Predict Sepsis and Sepsis-Related Mortality

et al. 2022

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Background. The aim of this study was to assess the role of prehospital point-of-care N-terminal probrain natriuretic peptide to predict sepsis, septic shock, or in-hospital sepsis-related mortality. Methods. A prospective, emergency medical service-delivered, prognostic, cohort study of adults evacuated by ambulance and admitted to emergency department between January 2020 and May 2021. The discriminative power of the predictive variable was assessed through a prediction model trained using the derivation cohort and evaluated by the area under the curve of the receiver operating characteristic on the validation cohort. Results. A total of 1,360 patients were enrolled with medical disease in the study. The occurrence of sepsis, septic shock, and in-hospital sepsis-related mortality was 6.4% (67 cases), 4.2% (44 cases), and 6.1% (64 cases). Prehospital National Early Warning Score 2 had superior predictive validity than quick Sequential Organ Failure Assessment and N-terminal probrain natriuretic peptide for detecting sepsis and septic shock, but N-terminal probrain natriuretic peptide outperformed both scores in in-hospital sepsis-related mortality estimation. Application of N-terminal probrain natriuretic peptide to subgroups of the other two scores improved the identification of sepsis, septic shock, and sepsis-related mortality in the group of patients with low-risk scoring. Conclusions. The incorporation of N-terminal probrain natriuretic peptide in prehospital care combined with already existing scores could improve the identification of sepsis, septic shock, and sepsis-related mortality.

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Section: Introductionmentioning

confidence: 99%

Combination of Prehospital NT-proBNP with qSOFA and NEWS to Predict Sepsis and Sepsis-Related Mortality

et al. 2022

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“…The last learning point is the overall unusual presentation of loxoscelism with facial nerve palsy as one of the first things noticed by the clinicians. Considering this patient's clinical deterioration and prolonged hospitalization, any sign preceding serious bacteremia and septic shock in similar cases can give physicians advance warning and the opportunity to treat these serious conditions early, which is crucial for the prognosis of this condition [ 16 ]. It is therefore particularly important to keep this link in mind when evaluating otherwise unimpressive integumentary symptoms and facial nerve paralysis of unknown etiology.…”

Section: Discussionmentioning

confidence: 99%

Spider Bite-Induced Facial Nerve Palsy

Stolzenberg¹,

Koch²,

Huang³

et al. 2022

Cureus

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Spider bites, while rarely confirmed beyond a doubt, should always be in the differential for any severe symptoms or infection out of proportion to presentation with the suspected presence of appropriate vectors. While most arthropod bites will only result in mild localized irritation, the potential to cause severe cutaneous and systemic effects should not be overlooked. We present one such case, in which a presumed brown recluse (Loxosceles reclusa) bite on the neck resulted in severe illness with systemic manifestations. The patient presented to the emergency room minimally responsive with left-sided facial nerve palsy and septic shock. While the admitting physician initially prioritized stabilizing the patient, he noted the leftsided cervical cellulitis. Thorough history taking revealed that the patient had been worsening since being bitten by a spider three days prior to admission. After a month-long hospital stay and multidisciplinary treatment, the patient was transferred to a larger center with facial paralysis still present.

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“…A key contributing factor to the high mortality in sepsis is the difficulty of a definitive and early diagnosis, which hinders the rapid and appropriate management of sepsis patients [ 16 , 17 ]. Treatment for sepsis varies and includes injecting modulators to neutralize pro-inflammatory cytokines to relieve inflammation and vasodilation [ 18 ]. However, the administration of these medications requires an assessment of the optimal dose and the patients’ immune status [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Pulsed Electromagnetic Field (PEMF) Treatment Reduces Lipopolysaccharide-Induced Septic Shock in Mice

Lee

Park

Hwang

et al. 2022

IJMS

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Despite advances in medicine, mortality due to sepsis has not decreased. Pulsed electromagnetic field (PEMF) therapy is emerging as an alternative treatment in many inflammation-related diseases. However, there are few studies on the application of PEMF therapy to sepsis. In the current study, we examined the effect of PEMF therapy on a mouse model of lipopolysaccharide (LPS)-induced septic shock. Mice injected with LPS and treated with PEMF showed higher survival rates compared with the LPS group. The increased survival was correlated with decreased levels of pro-inflammatory cytokine mRNA expression and lower serum nitric oxide levels and nitric oxide synthase 2 mRNA expression in the liver compared with the LPS group. In the PEMF + LPS group, there was less organ damage in the liver, lungs, spleen, and kidneys compared to the LPS group. To identify potential gene targets of PEMF treatment, microarray analysis was performed, and the results showed that 136 genes were up-regulated, and 267 genes were down-regulated in the PEMF + LPS group compared to the LPS group. These results suggest that PEMF treatment can dramatically decrease septic shock through the reduction of pro-inflammatory cytokine gene expression. In a clinical setting, PEMF may provide a beneficial effect for patients with bacteria-induced sepsis and reduce septic shock-induced mortality.

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Management of sepsis and septic shock in the emergency department

Cited by 79 publications

References 112 publications

Combination of Prehospital NT-proBNP with qSOFA and NEWS to Predict Sepsis and Sepsis-Related Mortality

Combination of Prehospital NT-proBNP with qSOFA and NEWS to Predict Sepsis and Sepsis-Related Mortality

Spider Bite-Induced Facial Nerve Palsy

Pulsed Electromagnetic Field (PEMF) Treatment Reduces Lipopolysaccharide-Induced Septic Shock in Mice

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