๊ณ ๋ น ์‘๊ธ‰์‹ค ํŒจํ˜ˆ์ฆ / Sepsis in older emergency department patients

์ •์˜

๊ณ ๋ น ์‘๊ธ‰์‹ค ํ™˜์ž์—์„œ ํŒจํ˜ˆ์ฆ์ด ๋น„์ „ํ˜•์ ์œผ๋กœ ๋‚˜ํƒ€๋‚˜๊ฑฐ๋‚˜ ๊ธฐ์กด sepsis screening score์˜ ์„ฑ๋Šฅ์ด ๋‹ฌ๋ผ์งˆ ์ˆ˜ ์žˆ๋Š” ์ž„์ƒ ์ฃผ์ œ์ด๋‹ค.

์ž„์ƒ ํ•ต์‹ฌ

์ Š์€ ํ™˜์ž๋Š” fever, tachycardia, leukocytosis๊ฐ€ ๋น„๊ต์  ์ž˜ ๋ณด์ผ ์ˆ˜ ์žˆ๋‹ค. ๊ณ ๋ น ํ™˜์ž๋Š” afebrile presentation, delirium, weakness, poor oral intake์ฒ˜๋Ÿผ ๋น„ํŠน์ด์  ์–‘์ƒ์œผ๋กœ ๋‚˜ํƒ€๋‚  ์ˆ˜ ์žˆ๋‹ค. Fever absence๊ฐ€ mortality ๋˜๋Š” delayed antibiotics์™€ ๊ด€๋ จ๋˜๋Š”์ง€๊ฐ€ ์ค‘์š”ํ•œ ์—ฐ๊ตฌ ์งˆ๋ฌธ์ด๋‹ค. Delirium์ด sepsis์˜ ๋…๋ฆฝ ์˜ˆ์ธก์ธ์ž์ธ์ง€๋„ ์ž„์ƒ์ ์œผ๋กœ ์ค‘์š”ํ•˜๋‹ค.

์ง„๋‹จ

qSOFA, SIRS, NEWS2๊ฐ€ ๊ณ ๋ น๊ตฐ์—์„œ ์„ฑ๋Šฅ์ด ๋–จ์–ด์ง€๋Š”์ง€ ๊ฒ€์ฆํ•˜๋Š” ๊ฒƒ์ด ํ•ต์‹ฌ์ด๋‹ค. ๋น„ํŠน์ด ์ฆ์ƒ๊ณผ ์ •์ƒ ๋˜๋Š” ๋‘”ํ™”๋œ ํ™œ๋ ฅ์ง•ํ›„ ๋•Œ๋ฌธ์— occult sepsis ๊ฐ€๋Šฅ์„ฑ์„ ๊ณ ๋ คํ•ด์•ผ ํ•œ๋‹ค.

์น˜๋ฃŒ

๋ชฉํ‘œ๋Š” delayed antibiotics๋ฅผ ์ค„์ด๊ณ , ๊ณ ๋ น๊ตฐ์— ๋งž๋Š” sepsis recognition ๋ฐ risk stratification pathway๋ฅผ ๋งŒ๋“œ๋Š” ๊ฒƒ์ด๋‹ค.

์ถœ์ฒ˜

Surviving Sepsis Campaign 2021, ACEP geriatric ED ์ž๋ฃŒ๊ฐ€ raw ์ž๋ฃŒ์—์„œ ์–ธ๊ธ‰๋˜์—ˆ๋‹ค.

๐ŸŒฑ ์ถœ์ฒ˜ raw


๋ณธ ๋ฌธ์„œ๋Š” ํ•™์Šตยท์ฐธ๊ณ ์šฉ์ด๋ฉฐ ์‹ค์ œ ์ง„๋ฃŒ ๊ฒฐ์ •์€ ์ž„์ƒ์˜์˜ ํŒ๋‹จ์ž…๋‹ˆ๋‹ค.