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FEATURE

Now the process of figuring out what happened. His nurse that You get the point. The so-called-severe-sepsis-alert protocol re-
night was gone — probably forever. The charge nurse handed me quires two of the following four parameters: 1) temp >100.4 or
a neatly-printed sheet entitled Severe Sepsis Alert Worksheet. <96.8 2) HR>90 3) RR>20 4) WBC >12 or <4. Congratulations.
Ohhhh. Now they throw in the “Severe.” That’s not what’s an- You have just described a typical post-operative patient (at least
nounced overhead. The hospital operator does not say “severe sep- mine). I might as well put “sepsis alert” in my post-op orders!
sis alert,” just (ordinary) “sepsis alert.” Next, I’m told that the In case you missed it, some of the above is tongue-in-cheek.
patient’s temperature was 100-something degrees. Okaaaaaay. He Here’s my humble suggestion. Downgrade sepsis alert from Cat-5
just had surgery. Maybe a touch of atelectasis? A little metabolic up- Hurricane to tropical storm. Don’t announce it overhead to be fol-
shift to deal with an inflammatory/healing response? Now — that’s lowed by a D-Day style land invasion of a patient’s room (which
not all. His heartrate was greater than ninety. Well duhhh — why nearly put my patient into V-tach and his wife in a car wreck as she
didn’t you tell me? There’s this thing called pain (the fourth vital rocketed to the hospital). Replace the SWAT team with a demure
sign). It happens when a knife cuts through skin and muscle and RN cradling a clipboard, who reviews the chart, knocks politely on
bone and… There’s this other thing known as stress, anxiety, the door, and has a civilized chat with the patient. If it’s true sepsis
worry… His pre-operative heart rate was more than ninety. Now (which it rarely is by the way) then blow the whistle. If it’s not, then
doctor, there’s no need for sarcasm. Did I mention that the patient’s how about just phoning the attending to see what they wish to do.
respiratory rate was twenty and his WBC >12,000? The nurse (I’ve been involved in two such non-sepsis-alerts, and in neither case
pushes back, crosses her arms over her chest and gloats. Obviously, was I informed anything had happened.)
that explains it. Any fool can see that. Double Hmmmmm. There’s By the way, I just put in an application for a “Low Back Pain”
this thing called pain, stress, anxiety… wait a minute. I’ve already Alert.
said that. Okay. There’s this thing called blood loss. It happens with
surgery (most of the time and elevates both RR and HR). I consider Robert G. Johnson, MD, is an orthopaedic surgeon, a BCMS member and
a post-op hemoglobin of 10 gms/% a roaring success. A post-op a frequent contributor to San Antonio Medicine.
WBC of 12 to 18 is the norm.

visit us at www.bcms.org 35