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ERCAST


Welcome to ERCast, a focused discussion on the questions, quagmires and known unknowns we face everyday in the emergency department.

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Jan 27, 2016

What is sepsis? Even the world's experts can’t agree on what it means.  Is it infection plus organ dysfunction? That’s how surviving sepsis defines it. Is it infection with a whole body inflammatory respoinse? That’s how Wikipedia defines it. Is it two or more SIRS criteria plus infection?  All of these overlap in a Venn diagram that is what sepsis really is.

Take Home Points

  • Modified SIRS criteria: T>100.4 or <96.8 that’s over 38 or under 36 C, HR>90, RR>20, O2sat<90%, MAP<65, newALOC. Two or more plus infection/suspected infection = sepsis
  • Lactate is your buddy. Your clinical gestalt in sepsis isn't as good as you think. Use the lactate as part of your decision making in determining severity of sepsis
  • Resuscitate patients before intubating. Your patient is breathing hard (can increase venous return) and  hyper-adrenergic. Take those away and your patient will become hypotensive. They may have  sepsis induced cardiomyopathy. Positive pressure ventilation can cause hypotension. Be prepared for the blood pressure to crash. Before intubating, fluid resuscitate, start pressors (if needed) or at least have pressors ready.
  • Beware of transient hypotension in the seemingly not sick septic patient. It may be a warning sign that your patient is heading toward a bad outcome.
  • Get the right antibiotics on board early

Important stuff mentioned on this show