It has been a while since we did a sepsis and septic shock update, so the time has come! No better framework for the discussion than the most recent iteration of the Surviving Sepsis Campaign Guidelines. Foreshadowing: they don't suck as hard as in prior years.
The Guidelines
Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
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jeez Scott that was a long 46.5 minutes, but as you say, essential. and well done. I think there was even one study (am I wrong? ) that showed just shot-gunning with any (eg, Rocephin) in under an hour in suspected “septic ” (not septic-shock) patients did worse, the idea being that if not shocky, then stop, breathe, consider what the heck is going on (antibiogram , hx, source) and choosing the most appropriate antibiotic. I like your comment about hitting hard any hypotensive (or shock) patient : RUSH exam, broad spectrum antibiotics (regardless of “proof” of infectious etiology), A-line,… Read more »
Do y’all offer CUEs for nursing? I hear you talk about CME but those are not able to be applied for nursing.
hey stacey
CME is a encompassing term. Each episode offers both doc AMA Cat 1 and nursing CEUs
hi scott are you aware of any evidence or the rational of using B. blockers in sepsis/septic shock.
cheers great episode as usual.
there are at least 3 trials. just search for esmolol, norepinephrine, sepsis
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Screening: Really confused how/why this should be implemented. All scoring tools correlate with worse outcomes (higher scores = worse outcomes), but can’t find any evidence that bringing these scores to the attention of the ED clinician improves outcomes. We have been using QSOFA in ED as screening tool because it cuts way back on alarm fatigue and prioritizes the patients at highest risk and likely to benefit from early intervention. Which patients who screen positive for SIRS, MEWS, NEWS criteria and NOT positive for QSOFA would show a mortality benefit from all the early interventions (3 hour-abx, blood cultures, lactate,… Read more »
nobody is saying to use qsofa–guidelines have de-emphasized it
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I was searching for a blog on this topic from a very long time.
Source: https://www.tharwaniinfrastructures.com/millenia/
I was searching for a blog on this topic from a very long time.
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