Recognition of acute organ failure and associated fluid and oxygen resuscitation by emergency medical services of emergency department patients with a suspected infection

Int Emerg Nurs. 2019 Mar;43:92-98. doi: 10.1016/j.ienj.2018.11.002. Epub 2018 Dec 2.

Abstract

Introduction: Recognition of acute organ failure is essential for recognition and resuscitation of sepsis by emergency medical services (EMS). We assessed how many EMS patients with suspected infection had clinical signs of acute organ failure (i.e. hypotension), received fluids and oxygen, and how many EMS patients without clinical signs of organ failure appeared to have organ failure in the emergency department (ED).

Methods: We interrogated an existing database in which consecutive ED patients hospitalized with suspected infection were prospectively collected. Outcomes were 1) number of patients without clinical signs of organ failure in the ambulance who developed clinical signs of organ failure or appeared to have biochemical signs of organ failure (i.e. hyperlactatemia) in the ED, and 2) number of patients who received fluids and oxygen in the ambulance.

Results: Of the 788 analyzed EMS patients, 529 (67.1%) had clinical signs of organ failure, of whom only 161 (30.4%) received fluids and 372 (70.3%) received oxygen. Clinical signs of organ failure were absent in 259 (32.9%) EMS patients, of which 165 patients (63.7%) developed organ failure in the ED.

Conclusions: In patients with suspected infection, acute organ failure is poorly recognized and treated by EMS, partly because of delayed development of organ failure.

Keywords: Acute organ failure; Emergency medical services; Recognition; Resuscitation; Sepsis.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Emergency Medical Services / methods
  • Emergency Medical Services / standards
  • Emergency Medical Services / statistics & numerical data
  • Emergency Service, Hospital / organization & administration
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Fluid Therapy / methods
  • Fluid Therapy / standards*
  • Fluid Therapy / statistics & numerical data
  • Humans
  • Infections / complications*
  • Male
  • Middle Aged
  • Multiple Organ Failure / diagnosis*
  • Multiple Organ Failure / therapy
  • Netherlands
  • Oxygen Inhalation Therapy / methods
  • Oxygen Inhalation Therapy / standards*
  • Oxygen Inhalation Therapy / statistics & numerical data
  • Resuscitation / methods