I bring Josh on to discuss translating Andromeda-Shock 2 and other recent sepsis papers to the bedside.
See the Prior 2 Andromeda-Shock 2 Episodes
- EMCrit 411 – You Need to Understand the Andromeda-Shock-2 RCT for Septic Shock
- EMCrit Wee – ANDROMEDA-SHOCK-2 Explosion – A Discussion with the Lead Investigators
Big Tap Digital Stopwatch
Allows you to start and stop stopwatch by touching anywhere on the screen
IBCC Sepsis Chapter
IBCC Sepsis Protocol 2026
Perfusion Index Papers
Here is a PI Paper for Sepsis in the ED
Josh has a bunch more references in his chapter, linked above
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Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Latest posts by Scott Weingart, MD FCCM (see all)
- EMCrit Wee – EVERDAC RCT on Arterial Line Placement in the Medically Critically Ill - December 3, 2025
- EMCrit 413 – Translating Recent Sepsis Papers to the Bedside with PulmCrit (Farkas) - November 29, 2025
- EMCrit Wee – A Discussion of Opioid Adulterants with a Harm Reduction Specialist - November 21, 2025
Some pulse oximeters provide the pleth variability index in addition to the perfusion index. Do you think it might be useful to monitor the PVI in response to volume expansion in a spontaneously breathing patient? In theory, if the PVI decreases after volume expansion, this can only mean two things: either cardiac output has increased, or the patient’s inspiratory efforts have decreased, both of which are positive. If, however, the PVI increases after volume expansion, this can only mean that the patient’s inspiratory efforts have increased and therefore pulmonary congestion has worsened.
Great episode. My take away is that CRT is a bigger piece of the puzzle than previously believed but it’s not a panacea.
Particularly like the perspective on bradycardia in sepsis and using CRT as a ”test” of adequate heart rate. This has been a source of debate forever, with most of us just making the answer whatever seems convenient. Hopefully this approach supplies some guidance.
Happy my Speedmaster will get some more use!
always love hearing Josh talking, and especially the two of you guys together. a true pleasure.
I like Josh’s comment ” it’s like a chess game” with multiple possibilities (in the patients care).
love the idea of an early look at the patient’s heart (POC echo), I think that’s immensely wise. like when they hit the ambulance doors. it is nice to know if there’s a huge pericardial effusion , or an EF of 10%, I think.
thank you both, guys
tom fiero
emerge/resus
merced, calif