Sepsis is a challenging, dynamic, pathophysiology requiring expertise in diagnosis and management. Controversy exists as to the most sensitive early indicators of sepsis and sepsis severity. Patients presenting to the emergency department often lack complete history or clinical data that would point to optimal management. Awareness of these potential knowledge gaps is important for the emergency provider managing the septic patient. Specific areas of management including the initiation and management of mechanical ventilation, the appropriate disposition of the patient, and consideration of transfer to higher levels of care are reviewed.
Key points
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There have been recent changes in the diagnostic criteria for sepsis due to criticism of prior definitions.
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The diagnosis of sepsis is challenging in special patient populations (eg, the elderly, children, patients taking medications that alter typical physiologic responses).
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There is significant controversy in “bundled” care for septic patients because it is unclear which aspects are most helpful and which aspects may pose the potential for harm.
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The disposition of a septic patient out of the emergency department may be one of the most consequential decisions the treating clinician can make. It should be approached considering not only the patient’s condition in the emergency department but also their likely trajectory following admission.
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Strong consideration for transfer to a higher level of care should be made if it is not clear the resources required for the severity of illness can be met at their present institution.
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