Hello, med students. My name is Zach Olson and thank you for downloading this week's episode of the EM

Clerkship Podcast. When I put out my last sepsis episode, it was right around the time of

sepsis three and a new set of surviving sepsis recommendations. And my episode was just a little bit outdated.

I left some of that new stuff out on purpose, actually, because I wanted to see how things

settled out. But I think it's time to go over everything again. I'm starting to get confused on

my shifts. It turns out in the end, not a lot had changed really from the last episode,

but when you talk about this with your attending now, after listening to this today, you're

going to sound much more knowledgeable and updated. So I do think this is valuable for you to hear,

even though not a lot has changed as far as management.

What you need to know, everybody still agrees that sepsis is bad.

But the current problem, and it is a problem, is you have CMS with their rules,

you have surviving sepsis campaign with their rules, you have sepsis three with their rules. And then you have each hospital now with their take on things. And it's all different.

It's a disaster. It's a complete disaster. It's super confusing. There's no standard of care.

It started with sepsis three. Spsis three was a new set of proposed recommendations, and sepsis three proposed four things.

First, sepsis three wanted to completely get rid of SERS for sepsis screening and replace it with something

called Q SOFA. Those SERS criteria you learned, they wanted to eliminate them, make it so they

have no place in ED triage ever again, with the argument being that too many people had SERS who didn't have

sepsis, that SERS was way too sensitive and bringing in too many false positives.

So they recommended screening with something called Q Sofa, a different score instead.

Q Sofa was much more specific.

And QSofa was only three things.

Altered mental status, tachypnea, and hypotension.

...