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A lot of NYC hospitals want a non-invasive protocol for severe sepsis treatment. This is the one we are working on. If you get a chance take a look and tell me what you think in the comments section. I personally would be going invasive on many of these patients. But when surveyed, many ED docs have made it clear that they will not be placing central lines in normotensive patients.
–Scott
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This Post was by Scott D. Weingart, MD. We never spam; we hate spammers! Spammers probably work for the Joint Commission.
Hi, my name is Scott Weingart.
I am an ED Intensivist from New York City. My career goal and the purpose of this blog and podcast is to bring Upstairs Care, Downstairs-–that is to bring ICU level care to the ED, so our patients can receive optimum treatment the moment they roll through the door.
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Dr scott Everything looks good but one special catagory take care- old age with chest origin sepsis maintaining hemodynamics with your prtocol but if problem is sat 89 %90% better to intubate early as they will crsh like hell .
what is your say have you exprienced it ? If not take it -may be with a little salt.
Dr piyush (KUWAIT)
Dr. Piyush,
I definitely agree and in my personal practice, I wind up intubating almost all of my elderly patients with severe sepsis even if their saturations are holding. Old folks don’t do so swell with prolonged respiratory rates of 40-50.
scott
Scott:
Critical Care Ultrasound as per Daniel Lichtenstein( Paris)and Vicki Noble(Boston) have shown the advantage,ease and velocity which allows for diagnosis and better treatment of these patients.
I am suprised to have many of my own still request “a line”…
Raul
yep, in the hands of a skilled ultrasonographer; invasive monitoring becomes less attractive. Only annoying thing is no real-time monitoring.