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Is it a breach of ICU level care to fail to recognize or treat sepsis, including not using vasopressors or inotropes for low blood pressure? This is a question we have from one of our clients and I’m going to answer this question today.

My name is Patrik Hutzel from intensivecarehotline.com and this is another quick tip for families in intensive care.

Before I answer today’s questions, what makes me qualified to answer questions like this? I have worked in intensive care nursing for 25 years in 3 different countries where I worked as a nurse manager for over 5 years in critical care and intensive care. I’ve been consulting and advocating for families in intensive care here at intensivecarehotline.com since 2013. I can very confidently say that we have saved many lives for our clients and families in intensive care. You can verify that on our testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section where we have done client interviews.

So, let’s dive into today’s question from one of our clients, is it a breach of ICU level care to fail to recognize or treat sepsis, including not using vasopressors inotropes for low blood pressure?

Let me just illustrate what’s happening here. Patients in ICU that end up with sepsis often end up with low blood pressure, and then often vasopressors or inotropes are being used for that low blood pressure, because if the blood pressure is too low, there’s a high risk that vital organs are not being perfused with oxygen. That could end up with multi-organ failure and then potentially death.

So, let’s look at the answer in more detail from my research and experience, of course. So, it can be a breach of ICU level care to fail to recognize or treat sepsis, especially if the low blood pressure, which is also known as hypertension, is not treated with vasopressors or inotropes after adequate fluid resuscitation.

The first step often is in intensive care for low blood pressure with sepsis is fluid resuscitation, because that can increase blood pressure. It can also improve kidney perfusion because what also often happens in sepsis in ICU is that the kidneys aren’t being perfused because of the low blood pressure, and then patients go into kidney failure.

Sepsis is not being identified or addressed promptly despite clinical science. So, what are the clinical sign? Clinical signs are, generally speaking, high temperature, fever, or low temperature, also usually white cell count is going up, sign of an infection, and CRP (C-reactive Protein) is going up as well. Also, another inflammatory marker such as ESR (Erythrocyte Sedimentation Rate). Also, the infectious disease team should be involved for guidance on how to manage the sepsis that is important as well.

So, why does all of this matter? So, in ICU or in intensive care, the standard of care for sepsis requires that clinicians, doctors, and nurses recognize signs of sepsis early. Like I said, fever, elevated white cell count, ESR, CRP, also elevated lactate. Also, you will find often that there’s an altered mental status from patients, and obviously, the mentioned hypotension, which can also often go hand in hand with tachycardia or high heart rate to compensate for the low blood pressure. Also, a tachycardia or high heart rate is often also a sign of a fever and an infection.

So then, obviously, timely treatment needs to be started, including broad spectrum antibiotics within 1 hour until you can find the exact source of the infection. Like I said, IV (intravenous) fluids for resuscitation, usually at 30 mL per kg for adults, vasopressors or inotropes if blood pressure remains low after the fluids to maintain adequate organ perfusion, and the MAP or the mean arterial blood pressure needs to be greater than 65 millimeter per mercury. That is important, once again, for vital organ perfusion.

What are vasopressors and inotropes? In North America, they’re called norepinephrine, epinephrine, phenylephrine, vasopressin, dobutamine, dopamine, and milrinone. In countries like Australia or the U.K. they’re mainly called noradrenaline, adrenaline but also, vasopressin and, like I said, dobutamine, dopamine, and milrinone are the same names in those countries.

So, what is the vasopressor, inotropes doing? It’s basically constricting blood in the peripheral arteries and veins to get more blood to the heart and then increase blood pressure like that. So, if an ICU fails to monitor for these signs and responds quickly to worsening vital signs like persistent hypertension, or delays or withholds appropriate interventions like the vasopressors, or inotropes, or antibiotics, or antivirals, or antifungals, depending on the source of infection, then this could be seen as a deviation from the accepted standard of ICU care and potentially medical negligence, depending on the outcome.

Also, after broadband antibiotics have been started, it is important to find the source of the sepsis. So, what that means is the intensive care team needs to take a sputum sample, a urine sample, and a blood sample to locate the source of the sepsis. Then, find the right bacteria and then target it with the right antibiotic or if it’s a virus, target it with the right antivirus, if it’s a fungal infection, target it with the right antifungal infections.

Also, another thing that is very important, is to make sure there are no open wounds, make sure that it’s all covered, no pressure sores. So, that’s why pressure area care is so important in intensive care as well because as soon as there’s an open wound, it is much more likely that a patient might end up with sepsis.

So, I hope that answers your question.

Like I said, I’ve worked in critical care nursing for 25 years in 3 different countries where I worked as a nurse manager for over 5 years in intensive care and I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy. You can verify that on our testimonial section at intensivecarehotline.com, and you can verify it on our intensivecarehotline.com podcast section where we have done multiple client interviews.

Our advice is absolutely life-changing, because, like I said, we have saved many lives, because the biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care. That’s exactly what you are dealing with here.

So, that’s why you can join a growing number of members and clients that we have helped over the years. The right to improve their lives instantly, making sure that our clients can make informed decisions, have peace of mind, control, power and influence.

That’s why I one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. I also talk to doctors and nurses directly. I also represent you in family meetings with intensive care teams, and I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day in the membership area and via email and we answer all questions intensive care related. You also have exclusive access as a member to 21 e-books and 21 videos that I’ve personally written and recorded. All of that will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment, always.

All of that, you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care, click the like button, click the notification bell, comment below what you want to see next, what questions and insights you have from this video, and share the video with your friends and families.

I also do a weekly YouTube Live where I answer your questions live on a show. You will get notification for the YouTube live if you’re a subscriber to my YouTube channel, or if you’re a subscriber to my intensivecarehotline.com email newsletter at intensivecarehotline.com.

Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.

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