Page 35 - 2020 JSOM Winter

4. Long B, Koyfman A. Clinical mimics: an emergency medicine- 16. Fisher AD, Washburn G, Powell D, et al. Damage control resusci-
focused review of sepsis mimics. J Emerg Med. 2017;52(1):34–42. tation in prolonged field care. J Spec Oper Med. 2018;109–119.
5. Quick sepsis related organ failure assessment. qSOFA.org. 17. JTS. Nursing intervention in prolonged field care CPG, Jul 22,
6. National Early Warning Score (NEWS) 2. Determines the de- 2018. https://jts.amedd.army.mil/index.cfm/PI_CPGs/cpgs. Ac-
gree of illness of a patient and prompts critical care intervention. cessed Oct 2020.
https://www.mdcalc.com/national-early-warning-score-news-2. 18. Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin
Accessed Oct 2020. and saline for fluid resuscitation in the intensive care unit. N Engl
7. Balk RA. Systemic inflammatory response syndrome (SIRS): J Med. 2004;350(22):2247–2256.
where did it come from and is it still relevant today? Virulence. 19. Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign
2014;5(1):20-26. bundle: 2018 update. Intensive Care Med. 2018;44(6):925–928.
8. Mellhammar L, Linder A, Tverring J, et al. NEWS2 is superior 20. Chawla LS, Ostermann M, Forni L, et al. Broad spectrum vaso-
to qSOFA in detecting sepsis with organ dysfunction in the emer- pressors: a new approach to the initial management of septic
gency department. J Clin Med. 2019;8(8):1128. shock? Crit Care. 2019;124.
9. CCAT. The i-STAT portable blood analyzer in austere locations 21. JTS. Airway management in prolonged field care CPG, May 1,
CPG. Joint Trauma System, 2020. https://jts.amedd.army.mil 2020. https://jts.amedd.army.mil/index.cfm/PI_CPGs/cpgs. Ac-
/index.cfm/PI_CPGs/cpgs. Accessed Oct 2020. cessed Oct 2020.
10. Lin GL, McGinley JP, Drysdale SB, Pollard AJ. Epidemiol- 22. Prolonged Field Care Working Group. M.S.M.A.I.D. Applying
ogy and immune pathogenesis of viral sepsis. Front Immunol. the Pre- Anesthesia Checklist to SOF Medicine MSMAID Apply-
2018;9:2147. ing the Pre- anesthesia Checklist to SOF Medicine, 2015. https://
11. Rudd KE, Kissoon N, Limmathurotsakul D, et al. The global docplayer.net/29637654-M-s-m-a-i-d-applying-the-pre-anesthesia
burden of sepsis: barriers and potential solutions. Crit Care. -checklist-to-sof-medicine-msmaid-applying-the-pre-anesthesia
2018;22:232. -checklist-to-sof-medicine.html. Accessed Oct 2020.
12. Falagas ME, Karageorgopoulos DE, Leptidis J, Korbila IP. MRSA 23. CCAT. Mechanical ventilation CPG, Oct 22, 2013. https://jts
in Africa: filling the global map of antimicrobial resistance. PLoS .amedd.army.mil/index.cfm/PI_CPGs/cpgs. Accessed Oct 2020.
One. 2013;8(7):e68024. 24. Vasios WN 3rd, Pamplin JC, Powell D, et al. Teleconsultation in
13. World Health Organization. World malaria report, 2018. World prolonged field care position paper. J Spec Oper Med. 2017;17(3):
Health Organization. 141–144.
14. Petersen K, Riddle MS, Danko JR, et al. Trauma-related infec- 25. JTS. Analgesia and sedation management during prolonged field
tions in battlefield casualties from Iraq. Ann Surg. May 2007; care CPG, May 11, 2017. https://jts.amedd.army.mil/index.cfm
245(5):803-11. /PI_CPGs/cpgs. Accessed Oct 2020.
15. JTS. Acute traumatic wound management in the prolonged field 26. JTS. Nutrition support using enteral and parenteral methods
care setting CPG, Jul 24, 2017. https://jts.amedd.army.mil/index CPG, Aug 4, 2016. https://jts.amedd.army.mil/index.cfm/PI
.cfm/PI_CPGs/cpgs. Accessed Oct 2020. _CPGs/cpgs. Accessed Oct 2020.

APPENDIX A:
SEPSIS PATIENT MANAGEMENT CHECKLIST

If sepsis is suspected, the following checklist should be em- • Ensure a secure airway is in place, or the equipment for
ployed to begin treatment and set up a safety net for ongoing a definitive airway is on hand along with the elements
patient care: of M.S.M.A.I.D. (See JTS Airway Management for Pro-
• Placement of 2 IV access points (large-bore IV/IO). longed Field Care CPG.)
• Collect blood cultures ´ 2 (if available). • Search for the source of infection. Address this as ap-
• Start IVF with goal resuscitation of adequate urine out- propriate (wound care, removal of infected catheters,
put, up to maximum bolus of 30mL/kg (usually about surgical consultation, etc.)
2–3L). See Resuscitation recommendations. • Give the most appropriate antibiotics.
• Consider placement of advanced monitoring equipment • Call telemedicine consultant early and often.
(if available). • Take/give approach: Take—vital signs, neurologic as-
• Place a Foley catheter. sessment, wound/ skin infection exams, serum lactate
• Monitor all vital signs and continuously trend heart level, urine output (Foley catheter), rapid tests. Give—
rate, blood pressure, respiratory rate, and mental status antibiotics, fluids, oxygen (if available), Vasopressors
every 15 minutes on a flowsheet. (See JTS Documenta- (with telemedicine).
tion PFC CPG.) Temperature and urine output should • If providing nutrition, monitor for signs of GI upset or
be documented hourly. obstruction: nausea, abdominal pain, and abdominal
• Place on oxygen if indicated and available (for Spo distention.
2
< 92%).

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