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Sepsis, Severe Sepsis, And Septic Shock: Current Evidence For Emergency Department Management - $30.00
This issue includes 4 AMA PRA Category 1 CreditsTM; 4 ACEP category 1; 4 AAFP Prescribed credits; and 4 AOA Category 2B CME credits.
Author
Ethan Booker, MD, FACEP
Attending Physician, Department of Emergency Medicine, Washington Hospital Center, Washington, DC
Peer Reviewers
Julie Mayglothling, MD, FACEP
Assistant Professor, Department of Emergency Medicine, Department of Surgery, Division of Trauma/Critical Care, Virginia Commonwealth University, Richmond, VA
Joseph Shiber, MD, FACEP, FACP
Associate Professor of Emergency Medicine and Critical Care, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
Todd L. Slesinger, MD, FACEP, FCCM
Director, Fellowship Program in Critical Care Medicine, North Shore University Hospital, Manhasset, NY; Assistant Professor of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
Publication Date: May 1, 2011; Volume 13, Number 5
Excerpt from the issue...
In the middle of a busy shift, a patient arrives by ambulance from a local longterm care facility with a report of altered mental status. You enter the room to find a chronically ill-appearing 85-year-old man with fever, tachycardia, and hypotension, and it is instantly apparent that this patient is septic. What is not clear is what the source is, what modifications in treatment might be necessary based on preexisting microbial resistance, and which of the array of invasive resuscitation techniques are appropriate when meaningful recovery is questionable and efforts may not be desired by the patient and family. You order IV fluids and broad-spectrum antibiotics; send lab tests, including lactate and cultures of blood, urine, and sputum; and begin to review his extensive history to discuss goals of care with his family and primary doctor.
While reviewing these issues, a 54-year-old woman with a history of asthma is brought straight back from triage with respiratory distress. You listen to her lungs, expecting wheezes, but hear decreased lung sounds at the right base, preserved air movement elsewhere, and her skin radiates heat. Now, on the monitor, she has a heart rate of 135 beats per minute, blood pressure of 90/60 mm Hg, O2 saturation of 86%, and a temperature of 39.4° C (103°F). You again identify sepsis and instruct your team that you will be using your department’s severe sepsis protocol. Equipment for monitoring and procedures is assembled, your staff provides preprinted order and monitoring flow sheets, and the ICU is alerted. Within an hour, the patient is intubated, has a central line placed, and has received IV fluids, broad-spectrum antibiotics and norepinephrine, and you are pleased to see a MAP of 67 mm Hg, a lactate decreasing from an initial value of 7.0, CVP of 10, and ScvO2 of 78%.