The document discusses lactate levels and their use in identifying occult hypoperfusion and sepsis in pre-hospital patients. It describes a pilot study that uses pre-hospital lactate measurement and notification of "Sepsis Alert" to initiate early goal directed therapy for sepsis patients in the field. The study aims to determine if this approach can improve outcomes by earlier treatment of hypoperfusion and sepsis.

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38. Pre-Hospital Lactate and Mortality Litteton/Porter/Parker EMS Wayne Guerra, MD, MBA Critical Care 2008, 12: R160

39. The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study Litteton/Porter/Parker EMS Wayne Guerra, MD, MBA Critical Care 2008, 12: R160: http://ccforum.com/content/12/6/R160

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