Podcast 056 – Dr. Rivers on Severe Sepsis – Part III

Part III of Dr. Rivers’ talk on Severe Sepsis

Dr. Emanuel Rivers brought the concept of aggressive therapies for sepsis down to the Emergency Department with his seminal article on EGDT published in the NEJM in 2001. We were lucky enough to get an hour of his time to do a conference call with the NYC STOP Sepsis collaborative.

I broke the ~1 hour lecture into 3 parts.

If you haven’t already, check out Part I and Part II.

In Part III, Dr. Rivers discusses:

  •  Protein C?
  • Can you do EGDT in small community EDs?
  • How do you handle the tachycardic patient with severe sepsis?
  • Steroids in the ED?
  • Procalcitonin?

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Comments

  1. Mike Jasumback says:

    One thing I love about Dr. Rivers is his relatively rational approach to therapy. Intervene early, when appropriate and wait when appropriate. There’s a lot to learn from this.
    How many other disease states are out there in which an earlier intervention is as powerful?
    Pneumonia? Yes
    Status epilepticus? Yes
    ACS? Yes
    Others?

    Mike Jasumback, MD

  2. Minh Le Cong says:

    Thanks guys for a truly inspiring and informative podcast. Dr Rivers , you are a living legend. Scott, you are the international man of ED critical care.

    in regard to digoxin use in the tachycardic patient with sepsis, totally agree. I use it a lot and rarely have issues when you are using it for acute rate control. Usually with rapid AF but Rivers is right you can use it for any supra ventricular tachycardia includin sinus tachy. And if they have some heart failure element to their sepsis it’s a useful inotrope as well.

    • Minh, you are too kind! I’m glad to hear you like dig for these folks. I’ll have to give it a try. How long after giving it do you see any tangible change in the heart rate?

      s

      • Minh Le Cong says:

        Scott, generally you see a response within 60min after a 0.5mg IV load
        I give another 0.5mg dose depending upon the response at 1hr.
        You reduce the dose in renal dysfunction of course, generally halve the dose.

        • David Hersey says:

          Hello,

          Great advice. Suggested on rounds the other day for a tachy septic patient and it worked like a charm.

          Also, I have used Scott’s method; opiates. I transfered a septic patient from the ED the other day only on a Propofol infusion. Up went the Fentanyl and the patient settled.

          PS…Minh Le Cong: Did you post on Flight Web? You profile picture looks familar?

          Cheers,
          David

  3. Alex Guttman says:

    Great set of podcsts by Dr Rivers. One question with respect to digoxin use. I was always taught that dig has a vagotonic effect and would have little benefit in high sympathetic states (hence does not prevent exercised induced fibrillation). Would its effect as an inotrope indirectly reduce heart rate?

  4. KAUSHIK MAULIK says:

    PRICELESS PRESENTATION BY DR RIVERS, THANKS MATE.

    KAUSHIK

    SPECIALITY REGISTRAR IN ACUTE MEDICINE
    HEART OF ENGLAND, BIRMINGHAM, UK.

  5. elizabeth says:

    great talks!

    need your input. do you think early goal directed therapy w/ central line insertion should still be initiated even if a lactate of above 4 resolves or decreases after fluid resuscitation?

    thanks!

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  1. Severe Sepsis Talk by Emmanuel Rivers (Originally posted in EMCrit Blog) | Emergency Care says:

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