A Prehospital Screening Tool Utilizing End-Tidal Carbon Dioxide Predicts Sepsis And Severe Sepsis

Objective To determine the utility of a prehospital sepsis screening protocol utilizing systemic inflammatory response syndrome (SIRS) criteria and end-tidal carbon dioxide (ETCO2). Methods We conducted a prospective cohort study among sepsis alerts activated by emergency medical services during a 12 month period after the initiation of a new sepsis screening protocol utilizing ≥ 2 SIRS criteria and ETCO2 levels of ≤ 25 mmHg in patients with suspected infection. The outcomes of those that met all criteria of the protocol were compared to those that did not. The main outcome was the diagnosis of sepsis and severe sepsis. Secondary outcomes included mortality and in-hospital lactate levels. Results Of 330 sepsis alerts activated, 183 met all protocol criteria and 147 did not. Sepsis alerts that followed the protocol were more frequently diagnosed with sepsis (78% vs 43%, P \u3c.001) and severe sepsis (47% vs 7%, P \u3c.001), and had a higher mortality (11% vs 5%, P =.036). Low ETCO2 levels were the strongest predictor of sepsis (area under the ROC curve (AUC) of 0.99, 95% CI 0.99-1.00; P \u3c.001), severe sepsis (AUC 0.80, 95% CI 0.73-0.86; P \u3c.001), and mortality (AUC 0.70, 95% CI 0.57-0.83; P =.005) among all prehospital variables. Sepsis alerts that followed the protocol had a sensitivity of 90% (95% CI 81-95%), a specificity of 58% (95% CI 52-65%), and a negative predictive value of 93% (95% CI 87-97%) for severe sepsis. There were significant associations between prehospital ETCO2 and serum bicarbonate levels (r = 0.415, P \u3c.001), anion gap (r = - 0.322, P \u3c.001), and lactate (r = - 0.394, P \u3c.001). Conclusion A prehospital screening protocol utilizing SIRS criteria and ETCO2 predicts sepsis and severe sepsis, which could potentially decrease time to therapeutic intervention

Comparing Quick Sequential Organ Failure Assessment Scores to End-tidal Carbon Dioxide as Mortality Predictors in Prehospital Patients with Suspected Sepsis

Introduction: Early identification of sepsis significantly improves outcomes, suggesting a role for prehospital screening. An end-tidal carbon dioxide (ETCO 2) value ≤ 25 mmHg predicts mortality and severe sepsis when used as part of a prehospital screening tool. Recently, the Quick Sequential Organ Failure Assessment (qSOFA) score was also derived as a tool for predicting poor outcomes in potentially septic patients. Methods: We conducted a retrospective cohort study among patients transported by emergency medical services to compare the use of ETCO 2 ≤ 25 mmHg with qSOFA score of ≥ 2 as a predictor of mortality or diagnosis of severe sepsis in prehospital patients with suspected sepsis. Results: By comparison of receiver operator characteristic curves, ETCO 2 had a higher discriminatory power to predict mortality, sepsis, and severe sepsis than qSOFA. Conclusion: Both non-invasive measures were easily obtainable by prehospital personnel, with ETCO 2 performing slightly better as an outcome predictor

Ranking Programs: Medical Student Strategies.

BackgroundSelecting a training program is one of the most challenging choices an applicant to the Match has to make.DiscussionTo make an informed decision, applicants should do a comprehensive research and carefully plan their upcoming steps. Factors that might influence the applicants' decision include geography, program reputation, specific areas of academic focus, subspecialty interests, university-versus community-based training, length of training and interest in combined programs. Such information can be gathered from published material, websites, and personal advice (from faculty, residents and advisors). This process is time-consuming and stressful.ConclusionTherefore, in this article we elaborate on the above to facilitate this process for applicants

Characteristics of Road-Kill Locations of San Clemente Island Foxes

Mortalities from collisions with vehicles have created concern for the welfare of the San Clemente Island fox (Urocyon littoralis clementae); 1 of only 6 genetically distinct subspecies of island fox. To find possible solutions for minimizing these mortalities, we compared 9 characteristics of roads and roadsides at kill-sites and control-sites to ascertain whether certain features were associated with risk of collisions. We found that kill-sites were positively associated with the volume of traffic, and negatively associated with the distance of motorists’ visibility, which had not been previously identified for island foxes. Additionally, visual obstructions along roadsides (i.e., steep ditches and tall vegetation) showed some evidence of increasing mortalities. We also found that gravel mounds, a possible pseudo-barrier along roadsides, were associated with reduced mortalities. Speeds of vehicles, presence of drainages, cacti, and culverts, and seasonality showed minimal effects on road-kills. Our findings suggest that efforts to reduce mortalities should focus on roads with high volumes of traffic and high amounts of visual obstruction for motorists. Possible methods for reducing road-kills include installing signs and speed bumps on curves of roads, regular mowing of roadsides, constructing gravel-mound barriers along edges of roads, and educating motorists