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MacKenzie and Lever describe the management of sepsis in some detail.1 As one who is often responsible for the initial diagnosis and management, I find recommendations from the surviving sepsis campaign helpful. This campaign was formed in 2002 to combat worsening trends in the incidence and mortality relating to sepsis.2
This means that if a patient has two or more of the systemic inflammatory response criteria (box 1), then the six hour resuscitation bundle should be triggered (box 2). The first four steps can be carried out immediately on the ward. There has been clear evidence for the positive effect of these interventions on morbidity and mortality relating to sepsis.2 3 4
A recent audit we conducted in a district general hospital showed these interventions were not being instigated regularly—in patients fulfilling criteria for sepsis, only 57% had blood cultures within six hours, 30% had serum lactate measured, 53% had arterial blood gases measured, 80% were given empirical antibiotics, and 97% had adequate fluid resuscitation. Reports suggest that this reflects the situation elsewhere.5
Better education regarding these simple interventions would be a good start to tackling failings in the diagnosis and initial management of sepsis.
Competing interests: None declared.