Management of Septic Shock in the Remote Prehospital Setting

Abstract This study aims to assess the management of septic shock by air medical retrieval teams in the remote setting. A retrospective observational study was performed over 36 months. Sixty-seven adult patients who met the criteria for septic shock were included. Respiratory sepsis was the working...

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Bibliographic Details
Published in:Air medical journal 2016-07, Vol.35 (4), p.235-238
Main Authors: Joynes, Emma Lucy, MD, Martin, Jodie, BN, Ross, Mark, MD
Format: Article
Language:English
Subjects:
Administration, Intravenous
Anti-Bacterial Agents - therapeutic use
Australia
Catheterization, Central Venous
Catheterization, Peripheral
Emergency
Emergency Medical Services
Female
Fluid Therapy
Health administration
Humans
Intensive Care Units
Internal Medicine
Intubation, Intratracheal
Isotonic Solutions - therapeutic use
Length of Stay
Male
Middle Aged
Oxygen Inhalation Therapy
Respiratory Tract Infections - therapy
Retrospective Studies
Rural Population
Shock, Septic - therapy
Vasoconstrictor Agents - therapeutic use
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Summary:Abstract This study aims to assess the management of septic shock by air medical retrieval teams in the remote setting. A retrospective observational study was performed over 36 months. Sixty-seven adult patients who met the criteria for septic shock were included. Respiratory sepsis was the working diagnosis for 53% of patients; this was confirmed on intensive care unit (ICU) discharge in 39% of patients. Intravenous antibiotics and oxygen were delivered in over 90% of patients. Central and arterial line insertions were performed in 48% and 40% of patients, respectively, and 79% of patients were catheterized. Thirty-three percent of patients required intubation, and 80% of patients received an initial crystalloid fluid bolus of 20 mL/kg. Vasopressors were started in 89% of patients. Upon reaching definitive care, 91% of patients were admitted to a high-dependency or ICU setting, with a median length of ICU stay of 4 days and a 30-day mortality of 13%. Of those admitted to the ICU, intubation was required in 48%, new renal support in 20%, and blood pressure support in 84% of patients, respectively. Septic shock was recognized early and managed aggressively by remote retrieval teams, which may have contributed to the low mortality rate observed.
ISSN:1067-991X
1532-6497
DOI:10.1016/j.amj.2016.04.001