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/
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.
