Not all septic shock is created equal. Toxic shock syndrome is one of the most fulminant and dangerous forms of septic shock. It is one of the few infectious diseases capable of rapidly killing previously healthy young people. Most importantly, toxic shock syndrome requires targeted therapy – it often fails to respond to conventional therapy […]
Search Results for: septic shock
EM Nerd-The Case of the Deceitful Lantern
Since the publication of the sepsis trilogy, PROMISE, ARISE, and PROCESS 1,2,3, abruptly displaced early goal directed therapy (EGDT) as the cornerstone of sepsis management, we have been searching to fill the therapeutic vacuum its sudden departure left behind. The Center for Medicare and Medicaid Services (CMS) and the Surviving Sepsis Campaign (SSC) have both rushed […]
Top EMCCM Articles from Tim Ellender
Tim Ellender, EM Intensivist and all around cool guy just dropped his picks for the top EMCCM articles all trainees and attendings must read.
PulmCrit- Metabolic sepsis resuscitation: Strike hard, strike fast, no remorse
Escalation-deescalation There are roughly two strategies for adjusting the intensity of treatment: Titrated strategy: Treatment intensity is adjusted to match the severity of the disease. Escalation-deescalation strategy: Treatment intensity is increased rapidly to exceed disease severity and gain control of the disease. After the patient improves, treatment intensity is reduced. The best strategy depends on […]
PulmCrit: The surviving sepsis campaign 1-hour bundle is… back?
The surviving sepsis campaign (SSC) has had substantial problems dating back to its inception. The original backbone of the guidelines was a single-center trial by Rivers, which has largely been debunked.1–4 Initially the SSC was slow to let go of invasive early goal-directed therapy. The SSC has finally started eliminating older dogma (e.g., superior vena cava […]
Petition to retire the surviving sepsis campaign guidelines
We are disseminating an international petition that will allow clinicians to express their displeasure and concern over these guidelines. If you believe that our septic patients deserve more evidence-based guidelines, please stand with us.
EMCrit Wee – Sean Townsend of the SSC and the ProCESS Trial
I talk with a member of the surviving sepsis campaign steering committee re: ProCESS
Evidence for the Protocols
Evidence for Non-Invasive Protocol The paper that allowed us to start non-invasive protocols=gamechanger. [1. Jones AE, Shapiro NI, et al.; Emergency Medicine Shock Research Network (EMShockNet) Investigators. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010 Feb;303(8):739?46.] Is septic shock without lactate elevation as sick […]
EM Nerd-The Case of the Tardy Delegate Continues
In 2000 Fazzini et al published a paper comparing the use of ionization vs photoelectric smoke alarms in rural Alaskan homes (1). The authors noted that at the time of the article’s publication. the fire fatality rate for native Alaskans was 9.6 times the national rate and 3.5 times higher than the general rate in […]
Comments on the Sepsis Talks
Adam Drenzla wrote these excellent comments after listening to the Rivers’ Podcasts
Pulmcrit Wee- Vasopressin vs. norepinephrine for vasoplegic shock after cardiac surgery
Patients in the VANISH trial treated with vasopressin had a lower incidence of renal failure requiring hemodialysis. However, this was a secondary endpoint which seemed to contradict the primary endpoint (defined as a milder degree of kidney injury). New data may clarify this controversy.
CC Nerd-The Case of the Relative Insufficiency
When it comes to the efficacy of glucocorticoid therapy for the treatment of septic shock, we have existed in a state of ambiguity, torn between the results of two contradictory RCTs. The first, the Annane et al trial published in JAMA in 2002, suggested a mortality benefit in favor of the corticosteroid group in the […]
PulmCrit- Metabolic Resuscitation: Was the answer inside us all along?
Now that VITAMINS is published, it’s worth trying to look at the big picture of sepsis treatment with hydrocortisone, ascorbate, and thiamine (HAT). Marik et al. 2017: The beginning HAT therapy began with a single-center, before/after study.1 There was a stark mortality reduction following the routine adoption of HAT therapy in septic shock (figure below, […]
EMCrit 345 – I Guess We Need to Talk about CLOVERS and Fluids in Sepsis (Hopefully for the Last Time Ever)
CLOVERS Trial Primer and Fluids in Septic Shock
Renoresuscitation: Sepsis resuscitation designed to avoid long-term complications
0 Introduction 0 Over the last few years, I’ve gone through an almost 180-degree change in my conceptualization of septic shock. In a perfect world, this would be irrelevant. Ideally there would be sufficient randomized controlled trials (RCTs) to answer all important questions directly, and my opinions would be irrelevant. Unfortunately not. Reconceptualizing the disease […]
- « Previous Page
- 1
- 2
- 3
- 4
- …
- 22
- Next Page »