This episode discusses the criteria for diagnosing sepsis, prompt antibiotic administration, target mean arterial pressure (MAP) goal for septic shock patients, use of balanced crystalloids for resuscitation, early initiation of vasopressors, importance of source control, role of hydrocortisone, need for LP in meningitis cases, and the significance of early intervention in septic shock and sepsis.
Sepsis in the ED requires clinical judgment to differentiate from other causes of surge criteria elevation.
In septic shock, initiating broad-spectrum antibiotics within the first hour, starting peripheral vasopressors, and considering source control are crucial.
Deep dives
Identifying Sepsis Criteria
Sepsis in the ED is defined by two or more surge criteria, including respiratory rate, heart rate, and leukocytosis. However, surge criteria is not perfect and requires clinical judgment to differentiate septic patients from those with other causes for criteria elevation.
Initiating Antibiotics and Source Control
In septic shock, the most crucial step is initiating broad-spectrum antibiotics as soon as possible, ideally within the first hour. Peripheral vasopressors like norepinephrine can also be started early while waiting for central access. Additionally, source control is vital, with pneumonia, UTIs, and skin infections being common sources to consider.
Managing Septic Shock
For patients with septic shock, the mean arterial pressure goal is typically greater than 60 to 65 millimeters of mercury. Early vasopressors, like norepinephrine, should be administered after fluid resuscitation. Hydrocortisone is recommended for patients on vasopressors. Lactate levels and specific lab tests are not primary focuses for the boards.
We promise this isn't clickbait. Hospital administrators take note. We're covering what's important in sepsis care. Take a guess what we won't be covering.... It begins with an L and ends in -actate.
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Cite this podcast as: Briggs, Blake. 189. Sepsis: burn the stopwatches. September 11th, 2023. Accessed [date].
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