by Jon Cole and Meghan Spyres Jon: Meghan, thank you for joining me on this post. I’ve wanted to write about the logistics of high dose insulin (HDI) for some time now, but I have a lot of my own biases about where insulin belongs in the ordering of our therapies for sick cardiotoxic overdoses […]
0 Introduction 0 With publication of the PROCESS and ARISE trials, many hemodynamic goals are being disproven. There is a growing tide of nihilism. Should we should just give septic patients a couple bags of fluid, some antibiotics, and hope for the best? 0 Probably not. PROCESS and ARISE have showed us what we can […]
Young patient, lactate of 5.2, pneumonia… You know what you’re supposed to do–put in the central line and start early goal directed therapy. Problem is, most people can’t see sticking a central line in a patient that does not need pressors and otherwise looks well. Yet these patient have an annoying habit of going on to decompensate and perish. Well now there may be another way. Thanks to an article just published in JAMA, we may have a path to non-invasive treatment of severe sepsis. In this EMCrit Podcast, I interview Dr. Alan E. Jones, author of the article, Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. Then I discuss how this article changes the game when it comes to caring for severe sepsis patients.