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Atlanta Legal Nurse Consultant At "Not All Sepsis Is Created Equal"

Early recognition of local superinfection is often difficult with burn patients.

Atlanta, Georgia – WEBWIRE

"Sepsis is ever changing." Jillian Begin.

Atlanta legal nurse consultant Liz Buddenhagen, RN, attended the 2016 J.M. Still Burn Symposium at Chateau Elan in Braselton, Georgia on March 7, 2016.
Not All Sepsis Is Created Equal:
Jillian Begin, MSN, RN CEN, CNL talked about sepsis and reducing false positive sepsis screening in a burn intensive care unit. Definitions for sepsis and infection have many criteria routinely found in patients with extensive burns. Early recognition of local superinfection is often difficult, considering the complexity of the wound as well as systemic clinical signs generated by metabolic, hormonal and systemic inflammatory reactions present in major burns even though sepsis is absent.
Generally, following a burn injury, patients present with the criteria associated with “sepsis” without having an actual infection and/or sepsis existing:

  • Hyperthermia/Hypothermia
  • Tachycardia
  • Tachypnea
  • Leukocytosis.

According to the CDC, there are over 1 million cases of sepsis each year and it is the ninth leading cause of disease related deaths. Sepsis kills more than 258,000 Americans each year and leaves thousands of survivors with life changing after effects. The definition of sepsis is constantly changing and evolving.
Proposed Burn Sepsis Surveillance Guidelines:
Over 96 hours post initial resuscitation:
1. Temperature over 39 degrees Celsius or less than 36 degrees Celsius.
2. Overall hemodynamic instability.
3. Progressive tachypnea.
4. Thrombocytopenia.
5. Feed intolerance over 24 hours.
6. WBC less than 3.0 at over 96 hours post initial resuscitation.
7. Trending serum N- terminal pro-B-type natriuretic peptide (pro-BNP) levels can be used as an early indicator of sepsis.
Meeting 3 or more criteria should “TRIGGER” concern for infection/sepsis. 
The term systemic inflammatory response syndrome (SIRS) should not be applied to burn patients:

  • Patients with large burns are in a state of chronic systemic inflammatory stimulation.
  • Making traditional indicators of sepsis both insensitive and non-specific, as evidenced by: The Third International Consensus Definitions for Sepsis and Septic Shock, capture the evolution of the sepsis, severe sepsis and septic shock.

Going Forward:
A larger retrospective study is warranted.
Alternative screening methods should be explored.
A consensus definition of burn sepsis should be determined.
Atlanta Legal Nurse Consultant:
Liz Buddenhagen, RN, assists Atlanta attorneys with the medical aspects of their legal cases including personal injury, medical malpractice, wrongful death, car and truck collisions and legal malpractice. For more information, email , view or call 770-725-2997.

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