Septic Shock: Difference between revisions

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{{DX tag | Cardiovascular Problems | [[:Category: Medical Problem | Medical Problem]] | Septic Shock| SEPTIC SHOCK | [[ Septic Shock - 4400]] | No| 0 |'''Critical Care and Medicine''' | Currently Collected | |}}
{{PreICD10 dx | NewDxArticle = Shock, septic }}  


{{DX tag | Cardiovascular Problems | Medical Problem | Septic Shock| SEPTIC SHOCK | 4400 | No| 0 |'''Critical Care and Medicine''' | Currently Collected | |}}


Mutually exclusive with [[Severe Sepsis]]
Mutually exclusive with [[Severe Sepsis]]
Line 6: Line 7:
Also see [[Septicemia]] definition.
Also see [[Septicemia]] definition.


See [[QA Septic Shock]] audit started September 2009.
See [[QA Septic Shock]]- special project


==DEFINITION ==
Use definition in [[Shock, septic]]. <!-- as per AG in discussion at that page 2018-11-30 -->
===(1) Blood pressure (BP) criteria===
 
*If at least '''one''' of the following is present, code Septic Shock:
{{LegacyContent
** '''systolic BP''' < 90 mmHg for > 30 minutes '''and not responding to fluid resuscitation or'''
|explanation=use new definition in [[Shock, septic]]
** mean (m)BP < 65 mmHg '''''(is this an "and" to the next line?)'''''
|successor=[[Shock, septic]]
** BP '''drop''' of > 40 mmHg '''from baseline''' for  > 30 min '''or'''
|content=
** use of '''vasopressor''' to maintain systolic BP >= 90 mmHg in the '''absence of other causes''' of shock, e.g.:  
 
*** no hypovolemia
==Definition ==
*** no MI
Dr. Kumar would like to emphasize to collectors that SEPTIC SHOCK means shock is thought to be '''DRIVEN BY infection''' and not just associated with infection.  Example, if someone has another obvious cause of shock with infection (like massive hemorrhage with it), that does not mean it is combined hemorrhagic and septic shock.  Basically, septic shock '''should not be called''' if there '''is another obvious cause for shock'''.--[[User:TOstryzniuk|Trish Ostryzniuk]] 18:23, 2012 June 11 (CDT)
*** no pulmonary embolus
 
*If none of the BP criteria are met:
==Criteria for coding septic shock==
** see [[Severe Sepsis]]
*If at least '''one''' of the following is present:
** '''systolic BP''' < 90 mmHg for > 30 minutes '''and not responding to fluid resuscitation  
***'''or'''
** mean (m)BP < 65 mmHg for  > 30 min
***'''or'''
** BP '''drop''' of > 40 mmHg '''from baseline''' for  > 30 min  
***'''or'''
** use of '''vasopressor''' to maintain systolic BP >= 90 mmHg in the '''absence of other causes''' of shock, e.g. Go to: [[:Category: Shock | Other types of shock]]  


=== (2) Other Criteria ===
*Plus at least '''two''' of:  
Plus at least '''two''' of:  
* [[temperature]]  > 38.5 C
* [[temperature]]  > 38.5 C
* [[HR]]  > 90  
* [[HR]]  > 90  
* [[RR]]  > 20
* [[RR]]  > 20


=== (3) Organ Failure Criteria ===
Plus at least '''one''' of ('''organ failure'''):  
Plus at least '''one''' of ('''organ failure'''):  
* '''Neuro changes''': GCS < 14
* '''Neuro changes''': GCS < 14
Line 46: Line 52:
** NR >1.5
** NR >1.5


== Data  Integrity Rules ==
==Examples of other conditions that can cause shock:==
Septic shock (44-00) is mutually exclusive with 45-00 [[Severe Sepsis]].
*hypovolemia ([[Hypovolemic/Hemorrhagic Shock]])
 
*MI ([[Cardiogenic Shock]])
== Discussion 1 - Resolved April 19.10 ==
*pulmonary embolus
 
*liver failure
What time should I record as the 1st BP related to septic shock?
*pancreatitis
**FINAL answer: March 30th 2112 hrs.--[[User:TOstryzniuk|TOstryzniuk]] 12:51, 28 April 2010 (CDT)
*drug overdoses
*'''Mar 10''' admitted with HAP (e.coli, serratia, candida), pleural effusions, cardiomyopathy
*burns
*'''Mar 15''' pleural tap of the effusions
*Note: Although these conditions can cause shock on their own, if the patient has an obvious serious sepsis with shock, you can still code septic shock even with these conditions.  
*'''Mar 1'''8 cardiac arrest no cool
*If the above criteria are not met:
*'''Mar 20''' extubated
** see [[Severe Sepsis]]
*'''Mar 23''' Decreased LOC due to C02- reintubated
*'''Mar 24''' tracheostomy
*'''Mar 25''' C. diff positive
*'''Mar 25''' slow decline in Hgb addressed
*'''Mar 26''' abrupt decrease in Hgb from 81 to 68 Transfused
*'''Mar 27''' on and off belly pain. Tarry stool. Transfused. CT abd showed no evidence of a bleed.
*'''Mar 28''' Hgb again decreased to 68.  Transfused.
*'''Mar 29''' Gastroscopy showed non bleeding duodenal ulcer.  Suggested a colonoscopy but never done. WBC 9.9.  Afebrile. Still abd pain.  ABG 7.41 CO2 35 O2 68 (low from his normal).  Query ischemic gut. 
*'''Mar 30''' Lactate increased from 2.3 in the am to 6.5 at 2010. 
**CT abd at 2135 showed nothing definitive but ischemic colitis not ruled out.
**'''''2115 hrs first systolic BP less that 90''''',  '''started on neo'''.
**T-36.4 HR 133 RR 34 WBC 10.6 INR increased to 1.9  Urine output adequate.  ABG at 2210 7.20 CO2 47 PO2 77  Still query ischemic gut.
*'''Mar 31''' By 0805 Neo stopped and levo started. Temp 37 RR controlled at 20 **HR 100  WBC 1.8 Lactate 4.5 ABG 7.22 CO2 56 O2 74  Anuric Accucheck 2.1  **Pip taz ordered at 0810 and given at 0815.
***By 1215 Levo at 1.4 Amiodarone started for SVT and Accucheck continue to be low and D50 amps given.
**At 1320 a PA cath is inserted. T 38.3 CVP 12 PCWP 13 SVR 866 CI 2.5 Venous O2 35
**At 1715 CI 1.7 and SVR 1424 Ph 7.1 Lactate 10.7 Now definately cardiogenic shock
**At 2005 pt expires
*Blood cultures taken on Mar 31 were negative
*Sputum  from Mar 31 continues to show e.coli and candida
*Urine from Mar 31 e. coli now growing.
*Antibiotic hx:
**Cefotaxime Mar 10, 11, 12
**Cipro Mar 12, 13, 14, 15, 16, 17, 18, 19
**No antibiotics Mar 20-25
**Flagyl Mar 25, 26, 27, 28, 29, 30
**'''Pip-taz Mar 31'''
*For the septic study would I use the the '''first BP drop''' on '''Mar 30 at 2115''' even though they thought they were dealing with ischemic gut which was not entirely ruled out or the BP on Mar 31 at 0805 when the switched to levo and first ordered pip-taz when they now thought they were dealing with septic shock. If I record Mar 30th BP it will show a big delay in receiving the antibiotic.  Mar 31 too showed a mixed shock as evidenced by the PA numbers.--[[User:MWaschuk|MWaschuk]] 16:18, 12 April 2010 (CDT)
 
**Mary lou, this patient had a course of antibiotics for the HAP, then flagyl was started for the c.diff.  The ischemic gut clearly is a septic source and as soon as they knew they had an ischemic gut they should have started antibiotics.  If the first low BP was on '''Mar 30 at 2115''' this would be the time I would use.  ( I assume your BP was stable for the other prior septic sources of HAP and c.diff colitis).  --[[User:LKolesar|LKolesar]] 13:26, 13 April 2010 (CDT)
 
***Link to this page's discussion has been sent to Dr. Kendiss Olafson and Brenda Kline for further comment. Thank you for posting your discussion here. -[[User:TOstryzniuk|TOstryzniuk]] 11:56, 14 April 2010 (CDT)
 
****In my opinion, following review of the information from the discussion and the definition we are using, I agree with using the Mar. 30th drop in BP. Mary Lou provides appropriate rationale and L Kolesar provides supportive rationale. Please await Kendiss’ opinion before responding to the query. Brenda Kline, Wednesday, April 14, 2010 9:36 AM
_______________________________________
*****From: Kendiss Olafson Sent: Monday, April 19, 2010 1:37
*****I agree that septic shock onset should be recorded as Mar 30th.  The patient turned out to be septic and this is when they first dropped their blood pressure.  As a health team, part of the challenges in giving early antibiotics is identifying when we are dealing with septic shock versus other causes of hypotension.  In this example, if we pick a later time b/c we think it is reasonable that the team missed sepsis diagnosis when they first dropped the blood pressure, we make our data look better but we would lose the learning opportunity to identify strategies to avoid that error in the future. --Kendiss
 
== Discussion 2 - Resolved April 26, 2010==
*What should I record as first low BP in this case.--Marylou
**Final answer: First low BP April 16th at 17:26--[[User:TOstryzniuk|TOstryzniuk]] 12:54, 28 April 2010 (CDT)
 
*Here is another scenario:
*'''Apr 16 @ 1148 hrs''' - '''to ER''': with hematemesis and confusion, rhabdo and ARI.  '''BP ok'''. '''Temp N''',  WBC 10.6,  '''Hgb 124''',  '''Lactate 8.7''',  Creatinine 244 (elevated for this pt),  and elevated INR,  '''HR 110''',  '''RR 60'''.  Treatment included iv rate 200cc/hr with bicarb. 1.5 l n/s bolus
**1610 - CT shows no surgical issues
**1625 - intubated for increased WOB (work of breathing)
**'''1726'''- '''First drop in BP 81/57''' and '''started on dopamine'''
**1750 '''- To ICU'''.  '''Hgb now 80''' and given 2 units blood. '''CVP 13-17''' prior to blood.
*'''1930''' Dr. wrote in the chart that '''septic shock could not be ruled out''' so '''pip-taz''' was '''orderd empirically'''
**'''2100''' '''- First antibiotic (pip-taz) given empirically'''
**2150 - scoped and found esophagitis and old blood in stomach but no new bleeding.
*'''Apr 17''' @ '''0100 hrs:''' Hbg now 104.  '''CVP 18-20''' and still on '''levo (switched from dopamine)'''
**0635 - '''another drop in BP 82/53'''.  '''CVP 11''' treated with fluid and FFP
**0730 - Temp now 38
**1130 - Temp 38.3


*My question is this: '''Is the FIRST low BP related to sepsis on Apr 16th at 1726 or Apr 17th at 0625? The first BP drop could have been related to hypovolemia from bleeding'''?
=== Positive Culture nor required ===
**does the pt meets the criteria for septic shock '''after''' he was intubated and his BP first dropped on April 16 @ 1726 hrs? 
*'''a POSITIVE CULTURE''' is '''NOT required''' for '''septic shock'''
**I am not sure because his Hgb was 80 so the hypotension could be related to a bleed not noticed on the scope although his CVP was 13-17? 
*By April 17th @ 0100 hrs, his hgb is 104 and has had alot of fluid.  The '''next drop in BP is at 0625'''.  He is well hydrated now although his CVP is down to 11 and his temp begins to rise shortly after this. --[[User:MWaschuk|MWaschuk]], 20 April 2010 (CDT)


***Did the doctors make a diagnosis?  To me the lactate of 8.7 is certainly a red flag and usually means that there is ischemia somewhere like the gut.  If this is the case, it is obviously a septic source and antibiotics should be started in my opinion.  I would definitely use the first drop in BP on April 16 as the time of septic shock if pressors were started as well as if the other septic shock criteria were evident.  The drop in BP is not related to bleeding according to your data. --[[User:LKolesar|LKolesar]] 11:45, 21 April 2010 (CDT)  
*'''Dr. Kumar''' advised that we should not routinely code ''distributive shock'' as septic shock, it should be coded as "other shock.'' Because we do not have a code called "other shock" use: [[Hypotension NYD (not due to shock or post op)]]. --[[User:TOstryzniuk|Trish Ostryzniuk]] 18:21, 2012 June 11 (CDT)


*******A few questions for point of clarification:
== All other shock codes Available ==
#What is the admitting and working diagnosis?
Go to category: [[:Category: Shock | ''Shock'']]
#Please quantify BP parameters.
#What antibiotic was ordered April 16th at 2100h? Thanks--Brenda Kline, April 21.10 1012 hrs.


-Reply to Brenda's question above-
==Cross checks==
*at '''admission''' on '''April 16 at 1715'''- The '''working diagnosis''' was: '''upper GI bleed''', '''lactate acidosis NYD''' and '''shock due to hypovolemia'''.
* Septic shock (4400) is mutually exclusive with 4500 [[Severe Sepsis]].
**Surgery had assessed pt twice prior to admission to ICU and the pt did not have an acute abd.  **Entrance complaint: severe adb pain and leg pain. 
I don't think this was ever implemented, can't find any evidence of it. Do we need it?
**The pt's lipase was 2000 but surgery was not convinced he had acute pancreatitis because CT was unremarkable except for a 6cm AAA (non-leaking).
**The leg mottling was thought to be due to hypoperfusion secondary to shock as opposed to a thrombis.
*'''Apr 16th at 1726''' was the first drop in '''BP 81/57''' 
*'''April 16th @ 1930''' Dr. wrote in the chart that '''septic shock could not be ruled out''' so '''pip-taz''' was '''orderd empirically''' and was '''given at 2100 hrs'''.
*'''Apr 17th at 0635''' a second significant drop in '''BP 82/53''' (pt was on levophed at the time).
*'''Apr 18 at 1500''', 46 hrs after admission to ICU, the pt was '''transferred''' to '''HSC MICU''' with the '''working dx''' of '''metabolic acidosis secondary to hypovolemia shock''' and '''hypoperfusion plus or minus septic shock'''.--[[User:MWaschuk|MWaschuk]], 21 April 2010 (CDT)


* "query s tmp QASeptic Dx no tmp"
* [[query s tmp QASeptic tmp no dx]]


*Thanks for the update. This is a good example because of the multiple potential septic sources and standard practice of addressing hypovolemic shock. After reading Laura's response, she validated my initial thoughts, but I wanted that wee bit more info, which was provided. Thus, I agree with the first drop in BP as the start of septic shock (may be in combo with hypovolemic). HOWEVER, I do want to discuss further with Kendiss, or she may respond before I get a chance. I am impressed with the critical thinking that is going on around some of your cases. Thank you!--[[User:Bkline|Bkline]] 12:04, 22 April 2010 (CDT)
== Questions & Answers ==


*Link with updated information sent over the Kendiss.  Stay tuned.........--[[User:TOstryzniuk|TOstryzniuk]] 19:14, 22 April 2010 (CDT)
=== use your judgement ===
This case is challenging…..
#If the 1st criteria for low BP "IS" met but 2nd criteria is "NOT" met (which is tmp >38.5 or HR >90 or RR >20) examples may be patient is either sedated, ventilated, or patient is hypothermic or heart rate is less than 90 for what ever reason, would they still meet the definition of septic shock if only 1st and 3rd criteria (organ failure) are met? OR....do we code as [[Severe Sepsis]] (which includes organ failure but excludes low BP). If so, how do we capture the low BP?  [[Severe Sepsis]] is organ failure but excludes low BP.[[User: GHall |Gail Hall]], [[User: Jpeterson | Joyce Peterson]], [[User: Mlaporte | Marie Laporte]][[User:TOstryzniuk|Trish Ostryzniuk]] 15:52, 2012 June 1 (CDT)
#*Dr. Kumar & Roberts both advise this: use judgement, if it appears to be a shock '''related specifically to an infection''' and is being treated as such even though the criteria for (T,HR,RR) is not met for some of the above stated reasons, then code as septic shock  This is different from [[VAP]] because for VAP no one in the world agrees on a standard definition, that is why we stick to very specific criteria regarding VAP for our purposes. (as per Dr. Kumar).[[User:TOstryzniuk|Trish Ostryzniuk]] 18:15, 2012 June 11 (CDT)


   
=== shock that is not septic shock ===
Dr. Kumar has also advised that anyone who has shock due to liver failure, pancreatitis drug overdoses or burns '''WITHOUT overt evidence of major infection''' don't code as septic shock. In his audit he has seen a lot of these codes as septic shock.
#***Dr. Kumar would like to emphasize to collectors that SEPTIC SHOCK means shock is thought to be DRIVEN BY infection and not just associated with infection.  Example, if someone has another obvious cause of shock with infection (like massive hemorrhage with it), that does not mean it is combined hemorrhagic and septic shock.  Basically, septic shock should '''not''' be called if there is another obvious cause for shock.[[User:TOstryzniuk|Trish Ostryzniuk]] 18:15, 2012 June 11 (CDT)


*This patient had 2 things going on resulting in shock; GI bleed and non-GI bleed –cause, likely sepsis.  Was an actual septic source ever identified in this man?
=== does unmeasurably low BP count as "first low BP === 
Patient in ER with no measurable BP. Tx with fluids, still no measurable BP.  Difficulty inserting central line, suspected sepsis.  Started on dopamine in ER.  Also given antibiotic for suspected sepsis. '''Question''' is this, if BP unmeasurable or not registering but pt is being treated for septic shock is this the time of the first low BP ? I spoke to Kendiss this morning-the answer is "yes"-the  unmeasurable BP could be the first low BP for the study if the patient is thought to be is shock due to infection. --[[User:Mlaporte|Mlaporte]] 08:00, 2012 June 4 (CDT)[[User:TOstryzniuk|Trish Ostryzniuk]] 18:15, 2012 June 11 (CDT)


*I think his initial blood pressure drop on April 16, 17:26 was at least partially (or all) due to GI bleed.  He had a significant drop in haemoglobin with some blood seen on EGD.  By the next day, his shock was definitely not due to GI bleeding as his CVP is up and his haemoglobin is stable.  
=== should criteria include hypothermia? ===
*most criteria for septic shock include [[Hypothermia]].
**'''After''' of [[QASeptic]] Project is completed in June or July 2012, we will add hypothermia to septic shock criteria as per Kendiss Olfason. Critical Care QI team agree to add.  [[User:TOstryzniuk|Trish Ostryzniuk]] 18:15, 2012 June 11 (CDT)  
* Brought this up again at our staff meeting that should hypothermia should be in the criteria for septic shock as discussed in 2012?[[User:GHall|GHall]] 15:53, 2017 March 9 (CST)
** And? Was there an answer? Ttenbergen 16:12, 2017 March 9 (CST) No answer yet TBA.


*I think you could make an argument for 2 times:
=== criteria met initially, but resolved by "Arrive DtTm" ===
If a patient meets all criteria for septic shock and this was the reason they were accepted to the ICU, however by the time they arrive to the ICU hours later,their vital signs are stable, and their GCS has improved/creatinine has normalized how should this be coded? Would it still be coded as septic shock, or would it simply be coded as infection ie.)cellulitis/cystitis?[[User:Mlagadi|Mlagadi]]


#April 16th at 17:26; This patient’s CVP is not low and therefore there is a real good possibility that GI bleeding is not the only reason for shock at this point.  The doctor’s notes also put sepsis in the differential at this point.   
=== 80% coded correctly ===
#April 17th at 1 am.  The patient has been well resuscitated and his CVP is now 18-20.  He remains hypotensive and is switched to levophed.  It is clear now that GI bleed is no longer the cause of his hypotension and he is likely septic.
About 10% of cases of septic shock in the database are overtly miscoded and are really obviously something else.  Another 10% are not clearly septic shock.  80% are solidly coded.  This is higher than any other database he has used.[[User:TOstryzniuk|Trish Ostryzniuk]] 18:15, 2012 June 11 (CDT)
*I would favour listing the time of septic shock onset as April 16th at 17:26, however as stated above one could also make the argument for April 17th 1 am.-Kendiss
*It would be nice to compare with Dr Kumar which cases he felt were not true septic shock pictures and use that info to help us in fine tuning our data collecting.In other words to learn from our mistakes.
**Marylou, have you resolved?--[[User:TOstryzniuk|TOstryzniuk]] 13:03, 29 April 2010 (CDT)
***April 29.10 - Yes I have.  I sent the file in the last batch.  The pt was transfered to St B. and they had septic shock and hypovolemic shock as their admits so '''I opted to go with the second drop in BP as the first drop related to septic shock'''. Kendiss wrote that I would have an argument with either BP but seeing as they were treating the GI bleed first I chose the second drop for the study. [[User:MWaschuk|MWaschuk]]


}}


[[Category: Data Integrity Rules]]
[[Category:Shock (old)]]
[[Category:Diagnosis Coding]]
[[Category: Sepsis]]

Latest revision as of 16:45, 2022 April 14


Legacy Content

This page is about the pre-ICD10 diagnosis coding schema. See the ICD10 Diagnosis List, or the following for similar diagnoses in ICD10:Shock, septic

Click Expand to show legacy content.


edit dx infobox
Category/Organ
System: 		Category: Cardiovascular Problems (old)

Type:

Category: Medical Problem (old)

Main Diagnosis: Septic Shock
Sub Diagnosis: SEPTIC SHOCK
Diagnosis Code: 4400
Comorbid Diagnosis: No
Charlson Comorbid coding (pre ICD10): 0
Program: Critical Care and Medicine
Status: Currently Collected


Mutually exclusive with Severe Sepsis

Also see Septicemia definition.

See QA Septic Shock- special project

Use definition in Shock, septic.

Legacy Content

This page contains Legacy Content.

Click Expand to show legacy content.

Definition

Dr. Kumar would like to emphasize to collectors that SEPTIC SHOCK means shock is thought to be DRIVEN BY infection and not just associated with infection. Example, if someone has another obvious cause of shock with infection (like massive hemorrhage with it), that does not mean it is combined hemorrhagic and septic shock. Basically, septic shock should not be called if there is another obvious cause for shock.--Trish Ostryzniuk 18:23, 2012 June 11 (CDT)

Criteria for coding septic shock

  • If at least one of the following is present:
    • systolic BP < 90 mmHg for > 30 minutes and not responding to fluid resuscitation
      • or
    • mean (m)BP < 65 mmHg for > 30 min
      • or
    • BP drop of > 40 mmHg from baseline for > 30 min
      • or
    • use of vasopressor to maintain systolic BP >= 90 mmHg in the absence of other causes of shock, e.g. Go to: Other types of shock

Plus at least one of (organ failure):

  • Neuro changes: GCS < 14
  • Lactic Acidosis: at least one of
    • LA > 2.0 or
    • PH < 7.30 or
    • BE < 10
  • Oliguria: at least one of
    • urine < 0.5 cc/kg/hr or
    • urine output < 30 ml / hr or
    • serum creatinine increase > 40 uM from baseline
  • Hypoxia: at least one of
    • PaO2 < 75 on RA or
    • PaO2 / FiO2 ratio <280 (not valid due to pneumonia)
  • Coagulopathy: drop in platelets > 25% from baseline plus at least one of
    • > 25% PT or
    • > 25% PTT or
    • NR >1.5

Examples of other conditions that can cause shock:

  • hypovolemia (Hypovolemic/Hemorrhagic Shock)
  • MI (Cardiogenic Shock)
  • pulmonary embolus
  • liver failure
  • pancreatitis
  • drug overdoses
  • burns
  • Note: Although these conditions can cause shock on their own, if the patient has an obvious serious sepsis with shock, you can still code septic shock even with these conditions.
  • If the above criteria are not met:

Positive Culture nor required

  • a POSITIVE CULTURE is NOT required for septic shock

All other shock codes Available

Go to category: Shock

Cross checks

  • Septic shock (4400) is mutually exclusive with 4500 Severe Sepsis.

I don't think this was ever implemented, can't find any evidence of it. Do we need it?

Questions & Answers

use your judgement

  1. If the 1st criteria for low BP "IS" met but 2nd criteria is "NOT" met (which is tmp >38.5 or HR >90 or RR >20) examples may be patient is either sedated, ventilated, or patient is hypothermic or heart rate is less than 90 for what ever reason, would they still meet the definition of septic shock if only 1st and 3rd criteria (organ failure) are met? OR....do we code as Severe Sepsis (which includes organ failure but excludes low BP). If so, how do we capture the low BP? Severe Sepsis is organ failure but excludes low BP.Gail Hall, Joyce Peterson, Marie LaporteTrish Ostryzniuk 15:52, 2012 June 1 (CDT)
    • Dr. Kumar & Roberts both advise this: use judgement, if it appears to be a shock related specifically to an infection and is being treated as such even though the criteria for (T,HR,RR) is not met for some of the above stated reasons, then code as septic shock This is different from VAP because for VAP no one in the world agrees on a standard definition, that is why we stick to very specific criteria regarding VAP for our purposes. (as per Dr. Kumar).Trish Ostryzniuk 18:15, 2012 June 11 (CDT)

shock that is not septic shock

Dr. Kumar has also advised that anyone who has shock due to liver failure, pancreatitis drug overdoses or burns WITHOUT overt evidence of major infection don't code as septic shock. In his audit he has seen a lot of these codes as septic shock.

        • Dr. Kumar would like to emphasize to collectors that SEPTIC SHOCK means shock is thought to be DRIVEN BY infection and not just associated with infection. Example, if someone has another obvious cause of shock with infection (like massive hemorrhage with it), that does not mean it is combined hemorrhagic and septic shock. Basically, septic shock should not be called if there is another obvious cause for shock.Trish Ostryzniuk 18:15, 2012 June 11 (CDT)

does unmeasurably low BP count as "first low BP

Patient in ER with no measurable BP. Tx with fluids, still no measurable BP. Difficulty inserting central line, suspected sepsis. Started on dopamine in ER. Also given antibiotic for suspected sepsis. Question is this, if BP unmeasurable or not registering but pt is being treated for septic shock is this the time of the first low BP ? I spoke to Kendiss this morning-the answer is "yes"-the unmeasurable BP could be the first low BP for the study if the patient is thought to be is shock due to infection. --Mlaporte 08:00, 2012 June 4 (CDT)Trish Ostryzniuk 18:15, 2012 June 11 (CDT)

should criteria include hypothermia?

  • most criteria for septic shock include Hypothermia.
    • After of QASeptic Project is completed in June or July 2012, we will add hypothermia to septic shock criteria as per Kendiss Olfason. Critical Care QI team agree to add. Trish Ostryzniuk 18:15, 2012 June 11 (CDT)
  • Brought this up again at our staff meeting that should hypothermia should be in the criteria for septic shock as discussed in 2012?GHall 15:53, 2017 March 9 (CST)
    • And? Was there an answer? Ttenbergen 16:12, 2017 March 9 (CST) No answer yet TBA.

criteria met initially, but resolved by "Arrive DtTm"

If a patient meets all criteria for septic shock and this was the reason they were accepted to the ICU, however by the time they arrive to the ICU hours later,their vital signs are stable, and their GCS has improved/creatinine has normalized how should this be coded? Would it still be coded as septic shock, or would it simply be coded as infection ie.)cellulitis/cystitis?Mlagadi

80% coded correctly

About 10% of cases of septic shock in the database are overtly miscoded and are really obviously something else. Another 10% are not clearly septic shock. 80% are solidly coded. This is higher than any other database he has used.Trish Ostryzniuk 18:15, 2012 June 11 (CDT)

  • It would be nice to compare with Dr Kumar which cases he felt were not true septic shock pictures and use that info to help us in fine tuning our data collecting.In other words to learn from our mistakes.
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