Guided Resuscitation for Sepsis
from EMGuidewire's Podcast Hosted by Bryant Allen, MD
Join the EMGuideWire Crew as they continue to explore the High Yield management points for Sepsis! This week's Episode's Pearls: Early fluids save lives. Give 40cc/kg bolus in first 3 hours. But don't fluid overload the patient! U/S the heart and lungs: A plethoric IVC, immobile mitral valve, and B lines on the lungs should urge you to be more cautious with fluids. Goal in all patients is to establish an adequate MAP ASAP! Fluids + Vasopressors! Vasopressor titration algorithm: First low dose NE (10mcg/min); if still in shock, initiate vasopressin (0.04 units/min); do not wait on providing vasopressin if EPI is readily available (establish MAP ASAP!). Initiate vasopressors early with fluids! NE can be initiated peripherally, so don't wait for a central line! Only consider dopamine for absolute bradycardia. Methylene blue is a last resort consideration. Vasopressors are commonly needed at high doses (i.e., 1mcg/kg/min EPI). Hydrocortisone 50-100mg for patients with septic SHOCK, not sepsis alone. Summarized by: Travis Barlock, MD PGY-1 References: Farkas J. PulmCrit- Epinephrine challenge in sepsis: An empiric approach to catecholamines. EMCrit Project. https://emcrit.org/pulmcrit/epi/. Published August 21, 2018. Accessed September 17, 2019. Dellinger RP, Levy MM, Rhodes A, et al. 2017. Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup: Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2016. Critical Care Medicine. 44(3):486-552.
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