Guided Resuscitation for Sepsis

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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