An Introduction to the Most Complex Disease in Emergency Medicine

Jack Perkins, MD, FACEP, FAAEM, FACP, Editor

Michael E. Winters, MD, FACEP, FAAEM, Editor

Sepsis is one of the most complex and challenging diseases in medicine. Timely diagnosis and initiation of therapy are required in order to prevent unnecessary increases in patient morbidity and mortality. Unfortunately, the clinical presentation of sepsis is often nonspecific and may lead to delays in diagnosis and treatment. Since the majority of patients with sepsis initially present to the emergency department, it is imperative for the emergency provider (EP) to be knowledgeable regarding current concepts and controversies in sepsis management. Recent literature has improved our understanding of numerous critical aspects in sepsis management. In addition, the Centers for Medicare and Medicaid Services recently implemented a sepsis core measure (SEP-1) in the United States. SEP-1 contains several measures that are a matter of intense debate across the United States. Given these recent developments, we have dedicated this issue of Emergency Medicine Clinics of North America to a current evidence-based review of more than a dozen sepsis-related topics.

The initial articles of this special issue are dedicated to a discussion of the new definitions of sepsis and septic shock, the new “usual care,” current recommendations on appropriate antimicrobial therapy, fluid administration, source control, vasoactive medications for septic shock, and endpoints of sepsis resuscitation. Additional articles are dedicated to the prehospital resuscitation of septic patients, pearls in pediatric sepsis resuscitation, sepsis in austere settings, biomarkers, and sepsis care in special patient populations. The final three articles in this issue discuss common pearls and pitfalls in emergency department sepsis care, antimicrobial stewardship, and SEP-1. EPs should have a detailed understanding of SEP-1, as every hospital in the United States will be accountable to meet these metrics. Unfortunately, it appears that significant monetary penalties may be assessed against those hospitals that fail to achieve adequate compliance.

The authors of these articles represent more than a dozen institutions across the United States. They were selected based on their expertise and recognition as outstanding educators in emergency medicine and critical care. They have provided cutting-edge, up-to-date reviews of the critical concepts in sepsis recognition and treatment. Undoubtedly, sepsis will continue to be one of the most common critical illnesses encountered by the EP. We feel that this issue of Emergency Medicine Clinics of North America will be an essential resource for community and academic EPs alike. Ultimately, our goal is to provide each EP with the most up-to-date information so that emergency department patients with sepsis continue to receive outstanding care.

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