title: Management of Septic Shock in the Remote Prehospital Setting.
abstract: This study aims to assess the management of septic shock by air medical retrieval teams in the remote setting. A retrospective observational study was performed over 36 months. Sixty-seven adult patients who met the criteria for septic shock were included. Respiratory sepsis was the working diagnosis for 53% of patients; this was confirmed on intensive care unit (ICU) discharge in 39% of patients. Intravenous antibiotics and oxygen were delivered in over 90% of patients. Central and arterial line insertions were performed in 48% and 40% of patients, respectively, and 79% of patients were catheterized. Thirty-three percent of patients required intubation, and 80% of patients received an initial crystalloid fluid bolus of 20 mL/kg. Vasopressors were started in 89% of patients. Upon reaching definitive care, 91% of patients were admitted to a high-dependency or ICU setting, with a median length of ICU stay of 4 days and a 30-day mortality of 13%. Of those admitted to the ICU, intubation was required in 48%, new renal support in 20%, and blood pressure support in 84% of patients, respectively. Septic shock was recognized early and managed aggressively by remote retrieval teams, which may have contributed to the low mortality rate observed.
authors.affiliation: Careflight Darwin, Darwin Airport, Northern Territory, Australia. Electronic address: emmajoynes@doctors.org.uk.
authors.forename: Emma Lucy
authors.initials: EL
authors.lastname: Joynes
authors.affiliation: Careflight Darwin, Darwin Airport, Northern Territory, Australia.
authors.forename: Jodie
authors.initials: J
authors.lastname: Martin
authors.affiliation: Careflight Darwin, Darwin Airport, Northern Territory, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Ross
mesh_terms: D061605:Administration, Intravenous; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia; D002405:Catheterization, Central Venous; D002406:Catheterization, Peripheral; D000077324:Crystalloid Solutions; D004632:Emergency Medical Services; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D007552:Isotonic Solutions / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D012141:Respiratory Tract Infections / Q000628:therapy*; D012189:Retrospective Studies; D012424:Rural Population; D012772:Shock, Septic / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D014662:Vasoconstrictor Agents