Ep 122 Sepsis and Septic Shock – What Matters from EM Cases Course

This is Episode 122 - Sepsis and Septic Shock: What Matters, from the EM Cases Course 2019 In this podcast Dr. Sara Gray, intensivist and emergency physician, co-author of The CAEP Sepsis Guidelines, answers questions such as: How does one best recognize occult septic shock? How does SIRS, qSOFA and NEWS compare in predicting poor outcomes in septic patients? Which fluid and how much fluid is best for resuscitation of the septic shock patients? What are the indications for norepinephrine, and when in the resuscitation should it be given in light of the CENSER trial? What are the goals of resuscitation in the patient with sepsis or septic shock? When should antibiotics administered, given that the latest Surviving Sepsis Campaign Guidelines recommend that antibiotics be administered within one hour of arrival for all patients suspected of sepsis or septic shock? What are the indications for a second vasopressor after norepinephrine? Given the conflicting evidence for steroids in sepsis, what are the indications for steroids? Should we be considering steroids with Vitamin C and thiamine for patients in septic shock? What are the pitfalls of lactate interpretation, and how do serial lactates compare to capillary refill in predicting poor outcomes in light of the ANDROMEDA trial? Is procalcitonin a valuable prognostic indicator in septic patients? and many more...With interludes by Rory Spiegel on the ANDROMEDA-SHOCK RCT, Justin Morgenstern on the CENSER trial, and Rob Simard on the value of IVC girth and collapsibility for guiding fluid management in septic shock as well as George Kovacs on airway considerations in the septic shock patient. Podcast production, sound design & editing by Anton Helman Written Summary and blog post by Anton Helman, March, 2019 Cite this podcast as: Helman, A. Gray, S., Morgenstern, J., Spiegel R., Kovacs, G., Simard, R. Sepsis and Septic Shock - What Matters. Emergency Medicine Cases. March, 2019. https://emergencymedicinecases.com/sepsis-septic-shock. Accessed [date] The latest definitions of sepsis and septic shock As per the Third International Consensus Definitions for Sepsis and Septic Shock [1]: Sepsis is "life-threatening organ dysfunction caused by a dysregulated host response to infection" with a SOFA score ≥2. Septic shock is "a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone", identified clinically by a vasopressor requirement to maintain a MAP ≥ 65 and serum lactate ≥ 2 mmol/L in the absence of hypovolemia. Severe sepsis is no longer part of the definitions. What is the best clinical tool to aid in the recognition of sepsis and septic shock? While many cases of sepsis and septic shock are obvious clinically, occult septic shock may be missed early in the ED stay leading to poor outcomes. Early recognition of sepsis is essential. In cases that are not obvious, it is recommended to use a clinical tool to help prognosticate and guide management. A recent retrospective study compared the clinical tools SIRS, qSOFA, and NEWS (National Early Warning Score) for the early identification of sep...