#419 Rapid Response Series: Sepsis with Dr. Mohleen Kang A shock to the system
Dec 4, 2023
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Guest Dr. Mohleen Kang from Emory University joins the hosts to discuss sepsis recognition, initial management, sepsis scoring systems, diagnostic work-up, antibiotic management, fluids, pressors, and supportive measures for sepsis patients. They emphasize the importance of gathering patient information, evolving sepsis definitions, clinical diagnosis and imaging, antibiotic selection, prioritizing antibiotics for skin infections, management of sepsis, and identification and treatment of sepsis.
Appropriate fluid management, including considerations for fluids and pressor support, is crucial in the management of sepsis.
Diagnostic testing, such as obtaining blood cultures and lactic acid levels promptly, is important to identify the source of infection in septic patients.
Prompt administration of antibiotics and fluids within the first hour of presentation is crucial for patients suspected of sepsis, even without waiting for test results.
Deep dives
Start of Fee for CME Credits at VCU Health
Starting January 1st, 2024, VCU Health will begin charging a fee for each CME credit claimed. Listeners have the option to claim free CME credits for episodes aired before the mentioned date. The decision to charge a fee for CME credits is due to the unsustainable nature of offering them for free. The podcast extends gratitude to VCU Health for providing free CME credits to its listeners in the past.
Discussion on Sepsis and Importance of Fluid and Pressor Support
In this episode, the podcast delves into the topic of sepsis with guest Dr. Moline King, a pulmonary and critical care provider at Emory University. The discussion highlights the significance of appropriate fluid management, including considerations for fluids and pressor support. The episode provides insights on when to start vasopressors, the utilization of high-flow nasal cannula, and the importance of monitoring oxygenation levels. While steroids are mentioned as a potential intervention for shock resolution, it is clarified that steroids are typically reserved for cases where norepinephrine doses exceed 0.25 micrograms per kilogram per minute.
Considerations for Diagnostic Testing and Treatments
The podcast emphasizes the need for diagnostic testing to identify the source of infection in septic patients. It is recommended to obtain blood cultures and lactic acid levels promptly. The importance of considering necrotizing fasciitis, particularly in patients with rashes and surgical history, is highlighted. Antibiotics, such as vancomycin and MRSA coverage, are discussed for patients with suspected infection. The use of levofet and norepinephrine as primary vasopressors is recommended, and the option of using dopamine or epinephrine as alternatives in urgent situations is mentioned. The discussion also addresses the significance of fluid resuscitation and the use of central lines for patient access.
Early administration of antibiotics and fluids
It is crucial to promptly administer antibiotics and fluids to patients suspected of sepsis in the first hour of presentation, without waiting for test results or to guide treatment choices.
Considerations for managing critically ill patients
For critically ill patients with septic shock, early initiation of vasopressors may be necessary, even with peripheral access. Discussions around prognosis and palliative care should be initiated early for patients at high risk of mortality or those with chronic illnesses to ensure appropriate care and decision-making.
Join us for an infectious conversation about sepsis as we learn about the recognition and initial management of sepsis on the wards. We are joined by Dr. Mohleen Kang (@KangMohleen, Emory University).
Producers, Writers, and Hosts: Meredith Trubitt, MD and Monee Amin, MD
Show Notes: Meredith Trubitt, MD
Infographic and Cover Art: Sean Evans or Caroline Coleman
Reviewer: Leah Witt, MD
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
Technical Production: PodPaste
Guest: Mohleen Kang, MD, MSc
Transcript Disclaimer
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