Ep 122 Sepsis and Septic Shock – What Matters from EM Cases Course
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Mar 26, 2019 Recognizing occult septic shock, fluid choices in sepsis management, using IVC ultrasound as a marker for fluid resuscitation, clinical endpoints and timing of nor epinephrine administration, ongoing Clover's trial and Sensor trial, timely administration of antibiotics in septic shock, priorities of emergency doctors in sepsis management
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Individualized Fluid Volume Approach
- Tailor fluid volume to individual: give enough to maintain urine output and mentation.
- Avoid under-resuscitation even with comorbidities like CHF; intubate if necessary.
Multiple Endpoints For Fluid Resuscitation
- Use multiple endpoints like MAP, GCS, urine output, and IVC ultrasound to judge fluid resuscitation.
- Foley catheters help monitor urine and assess resuscitation adequacy in septic patients.
Early Norepinephrine Use
- Start norepinephrine early when MAP falls below 65 mmHg, even during fluid resuscitation.
- Do not delay vasopressors waiting for full fluid bolus if patient remains hypotensive.