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A COMPLEX SYSTEMS VIEW OF SEPSIS : IMPLICATIONS FOR NURSING

A COMPLEX SYSTEMS VIEW OF SEPSIS : IMPLICATIONS FOR NURSING. LTC Elizabeth A. Mann-Salinas, PhD, RN, CCRN, CCNS 1,2 Joan Engebretson, DrPH , AHN-BC, RN 2 Andriy Batchinsky, MD 1 1 US Army Institute of Surgical Research, San Antonio, TX

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A COMPLEX SYSTEMS VIEW OF SEPSIS : IMPLICATIONS FOR NURSING

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  1. A COMPLEX SYSTEMSVIEW OF SEPSIS:IMPLICATIONS FOR NURSING LTC Elizabeth A. Mann-Salinas, PhD, RN, CCRN, CCNS 1,2 Joan Engebretson, DrPH, AHN-BC, RN 2 Andriy Batchinsky, MD 1 1US Army Institute of Surgical Research, San Antonio, TX 2 University of Texas Health Science Center, Houston

  2. Complex Systems • Non-linear • Coupling • Sensitivity to initial conditions • Self-similarity • Emergence • Adaptability • Self-Organization • Connectivity • Robustness

  3. Light bulb changer Linear Complicated

  4. Complex Non-Linear

  5. Coupling 1 + 1 = 3

  6. Sensitivity to initial conditions

  7. Self-organization

  8. Fractals

  9. Self-similarity

  10. Emergence Novelty Irreducibility to component parts Unpredictable

  11. Adaptability

  12. Connectivity

  13. Robustness

  14. Intra-patient variability

  15. Bone et al. /

  16. Sepsis as a Complex System • Non-linear • Coupling • Sensitivity to initial conditions • Self-similarity • Emergence • Adaptability • Self-Organization • Connectivity • Robustness

  17. Sepsis

  18. IV Immunoglobin Organ Support Corticosteroids Early Appropriate ABX Xigris ™

  19. Surviving Sepsis Campaign

  20. Surgical Intensive Care Unit USNS Comfort Hospital Ship, Persian Gulf, 2003

  21. Pattern Recognition • Data display • “Sniffers” • Smart alarms • Computer decision support systems

  22. Traditional Data Display

  23. Novel Data Display

  24. “Sniffer”

  25. Smart Alarm Date   : 13-Mar-11 11:10:09Bed    : 4N-4702Reasons:Less than 0.5 ml/kg per hour for more than 6 hours       UOP for hour 11:00 = 0.0 ml/kg       UOP for hour 10:00 = 0.0 ml/kg       UOP for hour 09:00 = 0.0 ml/kg       UOP for hour 08:00 = 0.0 ml/kg       UOP for hour 07:00 = 0.0 ml/kg       UOP for hour 06:00 = 0.0 ml/kgVital Signs at 13-Mar-11 11:10:09:       Heart Rate    = 129 bpm       Blood Pressure:             Systolic  = 98 mmHg             Diastolic = 63 mmHg             MAP       = 73 mmHg       Last Serum Creatinine    = N/AAttending Physician Email: david.zonies@amedd.army.milThis email is automatically generated.Questions can be directed to Dr. Jose Salinas.Tel: 210-916-0806 or jose.salinas@amedd.army.mil.NOTE:  The information contained in this message may be privileged andconfidential and protected from disclosure.  If the reader of thismessage is not the intended recipient, or an employee or agentresponsible for delivering this message to the intended recipient, youare hereby notified that any dissemination, distribution or copying ofthis communication is strictly prohibited.If you have received this communication in error, please notify Dr. JoseSalinas immediately and delete it from your Computer.

  26. CDSS

  27. WVSM

  28. Burn Resuscitation CDSS

  29. Is sepsis a complex system?

  30. Thank You!

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