Template:ICD10 Guideline Sepsis: Difference between revisions
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**[[Severe sepsis]] -- defined as sepsis PLUS one or more acute organ failures | **[[Severe sepsis]] -- defined as sepsis PLUS one or more acute organ failures | ||
**[[Shock, septic]] -- defined as severe sepsis where an acute organ failure is the cardiovascular system (see criteria below) | **[[Shock, septic]] -- defined as severe sepsis where an acute organ failure is the cardiovascular system (see criteria below) | ||
==== When to code an [[Admit Diagnosis]] vs [[Acquired Diagnosis]] ==== | |||
**There are sometimes subtle issues here, especially for diagnoses that use lab test results. | |||
**An example is patient comes in to ED with shock presumed due to pneumonia and a lactate=1.7 --> this doesn't meet the requirement for [[Shock, septic]], but by 3 hours later the next lactate checked in the ICU is 2.7, so that threshold for septic shock IS met. Clearly this person was "brewing" septic shock at admission and it seems logical to include that diagnosis as an admit diagnosis. THUS -- in such cases where it seems pretty clear, in retrospect, that a diagnosis was brewing/present at admission but only became fully evident after admission, that diagnosis SHOULD be coded as an [[Admit Diagnosis]] IF it becomes fully evident within 6 hours of admission. | |||
*Note that an individual during a single episode of illness can evolve over time from a less advanced to a more advanced subtype of sepsis --- and as this occurs, make sure to code the more advanced subtypes as they occur | *Note that an individual during a single episode of illness can evolve over time from a less advanced to a more advanced subtype of sepsis --- and as this occurs, make sure to code the more advanced subtypes as they occur | ||
**e.g. admitted on Monday with '''[[Severe sepsis]]''' which is coded, but by Tuesday has progressed to '''[[Shock, septic]]''' which should then be added to the codes, in this case as an [[Acquired Diagnosis]]. | **e.g. admitted on Monday with '''[[Severe sepsis]]''' which is coded, but by Tuesday has progressed to '''[[Shock, septic]]''' which should then be added to the codes, in this case as an [[Acquired Diagnosis]]. | ||
**however, as a person improves there is NO NEED to "downcode" their sepsis | **however, as a person improves there is NO NEED to "downcode" their sepsis | ||
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*Persisting hypotension requiring vasopressors to maintain MAP>65mmHg ''AND'' serum lactate>2 mmol/L -- both despite adequate volume resuscitation. | *Persisting hypotension requiring vasopressors to maintain MAP>65mmHg ''AND'' serum lactate>2 mmol/L -- both despite adequate volume resuscitation. | ||
{{DiscussTask| How hard of a rule is lactate >2? If they meet the criteria for septic shock with the exception of a high enough lactate, can we code septic shock [[User:Lkaita|Lisa Kaita]] 12:17, 2024 April 17 (CDT) }} | {{DiscussTask| How hard of a rule is lactate >2? If they meet the criteria for septic shock with the exception of a high enough lactate, can we code septic shock [[User:Lkaita|Lisa Kaita]] 12:17, 2024 April 17 (CDT) | ||
*discussed at TASK April 24, Dr Ziegler is researching various definitions of septic shock and will speak to this at next TASK [[User:Lkaita|Lisa Kaita]] 19:57, 2024 April 24 (CDT) }} | |||
*The CAUSE is proven infection OR '''presumed''' infection -- thus positive cultures are not required. | *The CAUSE is proven infection OR '''presumed''' infection -- thus positive cultures are not required. | ||
{{Ex | if someone has another obvious cause of shock (e.g. massive hemorrhage) and ''also'' has infection, that does not mean it is combined hemorrhagic and septic shock. Basically, septic shock '''should not be called''' if there '''is another more obvious cause for shock'''.}} | {{Ex | if someone has another obvious cause of shock (e.g. massive hemorrhage) and ''also'' has infection, that does not mean it is combined hemorrhagic and septic shock. Basically, septic shock '''should not be called''' if there '''is another more obvious cause for shock'''.}} | ||