Severe Sepsis in Adults in the Emergency Department

摘要

Epidemiology of severe sepsis in intensive care units is well known and account for 15 of admissions. Hospital mortality is about 30. Infectious focus is in order of frequency, pulmonary, urinary, digestive, skin and primitive bacteremia. It is less known in Emergency Departments but account for 500,000 annual visits in the United States. Incidence of these affections is increasing since 1980. Definitions have been made by consensus conferences and are now applied worldwide. Early recognition of severe sepsis on hospital admission remains an essential step but is difficult since the clinical presentation of this syndrome is not univocal. The Surviving Sepsis Campaign guidelines emphasize on a rapid and intensive management which allows to decrease the attributable mortality. This management included a rapid and important fluid challenge based on crystalloids, early administration of noradrenalin and broad spectrum antibiotherapy within the first hour after recognition of the severe sepsis. Bundles at three and six hours are proposed. Propositions of antibiotherapy based on recent recommendations of scientific societies or consensus conferences are displayed. A continuum of care between Smur, emergency department and intensive care unit must be the guarantor of early and adapted care that guarantee the lowest possible attributable mortality.