Summary
Sepsis in the emergency department: key points, controversies, and proposals for improvements in Latin America
Julián Jiménez A, Supino M, López Tapia, JD, Ulloa González, C, Vargas Téllez, LE, González Del Castillo J, Moyá Álvarez, A, Loro Chero, L, González Bascuñán U, Candel González FJ, Garza Sáenz, OG, Rosas Romero, FA, Gorordo Delsol, LA
Affiliation of the authors
Emergency Department of the University Hospital Complex of Toledo, Toledo, Spain. INFURG-SEMES (Infections Working Group of the Spanish Society of Emergency Medicine SEMES). Emergency Department, Jackson Memorial Hospital, Miami, Florida, USA. American College of Emergency Physicians, USA. Emergency Department of the General Hospital of Zone 17 of Monterrey, Nuevo Leon, Mexico.Mexican Society of Emergency Medicine A.C., Mexico. 7University of Monterrey in San Pedro, Nuevo Leon, Mexico. 8Emergency Service of the Solidarity Hospital of Managua, Nicaragua. 9Nicaraguan Association of Emergency Medicine, Nicaragua. Clínica La Colina Emergency Department, Bogotá DC, Colombia. Latin American Association for Cooperation in Emergencies and Disasters, ALACED. Asociación Colombiana de Medicina de Urgencias y Emergencias, Colombia. Emergency Department of the Hospital Clínico San Carlos in Madrid, Spain. Emergency Department of the Hospital Dr. Rafael Ángel Calderón Guardia in San José, Costa Rica. Costa Rican Association of Emergency Physicians, Costa Rica. Faculty of Medicine of the Continental University of Lima, Peru. Peruvian Society of Emergency and Disaster Medicine, Peru. Emergency Service of the Hospital Clínico Universidad de Chile de Santiago, Región Metropolitana, Chile. Chilean Society of Emergency Medicine, Chile. Clinical Microbiology Service, Hospital Clínico San Carlos, Madrid, Spain. Emergency Department of the Santa Fé Foundation of Bogotá, Colombia. Adult Intensive Care Unit. Juarez de Mexico Hospital. Mexico City, Mexico.
DOI
Quote
Julián Jiménez A, Supino M, López Tapia, JD, Ulloa González, C, et al. Sepsis in the emergency department: key points, controversies, and proposals for improvements in Latin America. Emergencias. 2019;31:123-135
Summary
Although infection rates and the impact of infection on hospital emergency departments (EDs) are known or can be reliably estimated, the incidence and prevalence of sepsis vary in relation to which definitions or registers used. Sepsis is also well known to be under-diagnosed by physicians in general and by ED physicians in particular. Over half of sepsis cases are community-acquired, and 50% to 60% of patients in intensive care units (ICUs) with sepsis or septic shock are admitted directly from the ED. Pneumonia and urinary tract infections are the most common points of focus in sepsis, septic shock, bacteremia, and ED admissions to the ICU for infectious processes. For this article a multinational group of experts representing Latin American emergency medicine associations reviewed and analyzed similarities and differences in the epidemiology of sepsis in different geographic locations. We consider key aspects and geographic similarities and differences in the early identification of patients with severe sepsis; criteria that define the diagnosis; appropriate early antibiotic and fluid therapy; the roles of triage systems and multidisciplinary sepsis code units; and the use of biological markers in this time-dependent disease. We also discuss key points and strategies for improving the diagnosis, prognosis, and care of sepsis patients in the ED.