19: Infection, Sirs And Sepsis

If you sit on a patient long enough, infection has a greater chance of taking hold and progressing to sepsis, or you may receive a patient who has already been sick for days. Doc Jabon Ellis walks us through the full spectrum from infection and SIRS to sepsis, shock and death. Despite firm CoTCCC and ICRC recommendations for early antibiotics, in the past we may have foregone that luxury because of lighting fast evacuation times, maybe even thinking, ‘they’ll take care of it at the next echelon.’ A great medic should not only treat their patient but set them up for success at the next echelon, as sepsis is a testament to how poor care during the TCCC phases of care can cost our patients days and weeks in a hospital later. But what if you are your own next echelon? Point of injury to Role 1+ could be your own team house or single litter aid station. Go down the checklist on the right side of the PFC trending chart and make sure you are taking care of anything that could result in an infection. Have you given those antibiotics? How is your airway and respiratory care? Did you replace any dirty IV or IO sites you placed in the field? Are you doing all your procedures an as aseptic manner as much as possible? When will you debride? Are you doing everything you can to prevent pressure ulcers? When will you call for a telemedical consult? When your patient develops a fever? Blood pressure falling? Altered mental status? Do you know how to dilute your 1:1000 epinephrine to use as a push dose pressor? (It’s in the Tactical Medical Emergency Protocols) Is an Epi drip approriate, why or why not? How much fluid will you give to help prop up that BP? All questions that the medic prepared for PFC should be looking to answer. For more content, visit www.prolongedfieldcare.org