Traumacast EAST/AAST/AAST-AMC: SCC Review Series - Surgical Infections I
Jul 31, 2025
Scott Brakenridge, a renowned sepsis researcher at the University of Washington, joins surgical critical care fellow Erin White to tackle crucial topics in managing surgical infections. They discuss the early management of septic shock and the importance of following the Surviving Sepsis guidelines. The conversation dives into ventilator-associated pneumonia, highlighting preventive measures and treatment protocols. They also explore the complexities of managing C. diff infections and the innovative use of monoclonal antibodies in treating recurrent cases, offering fresh insights into critical care practices.
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Immediate Sepsis Resuscitation Steps
- Draw blood cultures and lactate, start broad-spectrum antibiotics, give 30 mL/kg crystalloid early, and reassess volume responsiveness frequently.
- Use dynamic bedside assessments like point-of-care ultrasound or passive leg raise during the first 1–6 hours.
Treat Sepsis Within The First Hour
- Implement the hour-one sepsis bundle: lactate, cultures, antibiotics, and initial fluids within the first hour of suspicion.
- Monitor and reassess hourly and add vasopressors when adequate volume is achieved to target MAP 65 mmHg.
Adjuncts And Fluid Choice In Refractory Shock
- For refractory septic shock consider corticosteroids and target glucose <180 mg/dL; do not rely on vitamin C or thiamine.
- Use balanced crystalloids (e.g., lactated Ringer's) as first-line fluid; colloids have limited indications.