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Septic Shock


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#1 Gila

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Posted 20 March 2014 - 07:12 PM

I recently had a discussion with a friend who turned me onto to some new material out of our friends at emcrit (Thanks Ronel!).

The original podcast with Dr. Marik's conclusions can be found here:

http://emcrit.org/po...-fluids-sepsis/

The response to Dr. Marik's lecture can be found here:
http://emcrit.org/po...-severe-sepsis/

I would strongly suggest people go through both the initial lecture and response before replying, but I would love to get every bodies take on this interesting issue. I hope this will result in productive dialogue.
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Christopher Bare
"Non fui, fui, non sum, non curo "

#2 ForeverLearning

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Posted 21 March 2014 - 04:50 AM

Any specific points you want to discuss? Such as low vs high fluids?


I listed to these podcasts when they initially came out and this is probably true in life and also in human physiology that middle ground is probably ideal. Swinging too far to the left little fluid or too far to the right aggressive fluid probably is not optimal. I'd agree with Scott that this little fluid strategy has already been "tested" with 500ml bolus and dopamine drip and patients left to die with great blood pressure on the monitor.

I think the most important thing here is yearly detection, to have screening tools, and actually listen to EMS notifications. I'll tell you honest truth that I work in the same city as Scott and placed notifications for sepsis patients with 2 SIRS criteria + source clearly established to the hospitals he works in and has "EGDT Protocols", only to be ignored by triage nurses and made us wait in line to triage so many times that I've lost count. So from my experience these holier-than-thou doc's only exists on podcasts and interwebs.
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#3 onearmwonder

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Posted 21 March 2014 - 02:45 PM

We actually may have to go back to the drawing board with EGDT. Recently released NEJM: http://www.emlitofno...y-knew-ye.html. Also look at the Glycocalyx discussion on Emcrit and Life In the Fast Lane.

Matt
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#4 Gila

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Posted 21 March 2014 - 04:25 PM

I do not have any specific areas I wanted to discuss, only curious to see how other people are looking at the issues. There is a spirited discussion on EM threads over at SDN over these podcasts that is quite interesting.
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Christopher Bare
"Non fui, fui, non sum, non curo "

#5 medic4cqb

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Posted 22 March 2014 - 02:10 PM

Any specific points you want to discuss? Such as low vs high fluids?
has "EGDT Protocols", only to be ignored by triage nurses and made us wait in line to triage so many times that I've lost count. So from my experience these holier-than-thou doc's only exists on podcasts and interwebs.


FL,

I'll have to agree with you there 100%. Everyone needs to be on the same page when it comes to managing these patients, because sepsis is real and it's a killer. Our local AACN chapter just presented on the 2014 Sepsis Campaign and wouldn't you know it... I just left a code on a pt that was identified as septic yesterday and now she's gone. Granted there were contributing co-morbidities that soiled her jacket, but something was missed somewhere. Like at your surrounding facilities, there are posters and handouts all around describing the campaign to fight a silence killer called, sepsis, yet here patients are still dying.

I recently heard that they were going to try and implement these mobile community clinics like in Houston, to provide education and early detection and this was one of the issues they hope to address with this initiative. I just hope it is taken seriously by the directors, so that it can actually get off the ground.
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Steve A., RN, CCRN, EMT-P

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#6 medic4cqb

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Posted 24 March 2014 - 03:55 PM

Just read this, this morning from pulmCCM:

http://pulmccm.org/m...59218-311650401
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Steve A., RN, CCRN, EMT-P

"The usefulness of a cup is in its emptiness..."
- Bruce Lee