Updates and Controversies in the Early Management of Sepsis and Septic Shock
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Updates and Controversies in the Early Management of Sepsis and Septic Shock
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Publication Date: October 2018 (Volume 20, Number 10)

CME: This issue includes 4 AMA PRA Category 1 Credits™; 4 ACEP Category I credits; 4 AAFP Prescribed credits; and 4 AOA Category 2 A or 2B CME credits. 

Authors

Faheem Guirgis, MD, FACEP
Associate Professor of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
 
Lauren Page Black, MD, MPH
Research Fellow, Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
 
Elizabeth L. DeVos, MD, MPH, FACEP
Associate Professor, Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
 
Peer Reviewers
 
Michael Allison, MD
Assistant Director, Adult Intensive Care Unit, Saint Agnes Hospital Center, Baltimore, MD
 
Jeremy Rose, MD, MPH
Assistant Medical Director, Emergency Medicine, Mount Sinai Beth Israel Hospital; Assistant Professor, Icahn School of Medicine at Mount Sinai, New York, NY
 
Eric M. Steinberg, DO, FACEP
Assistant Program Director, Emergency Medicine Residency, Mount Sinai Beth Israel; Assistant Professor of Emergency
 
Abstract
 
Sepsis is a common and life-threatening condition that requires early recognition and swift initial management. Diagnosis and treatment of sepsis and septic shock are fundamental for emergency clinicians, and include knowledge of clinical and laboratory indicators of subtle and overt organ dysfunction, infection source control, and protocols for prompt identification of the early signs of septic shock. This issue is a structured review of the literature on the management of sepsis, focusing on the current evidence, guidelines, and protocols.
 
Excerpt From This Issue

A 65-year-old man with COPD and diabetes presents from home with a productive cough (green sputum) for 1 week, dyspnea on exertion, and fever. Albuterol at home provided no relief. His vital signs are: heart rate, 102 beats/min; respiratory rate, 22 breaths/min; blood pressure, 130/89 mm Hg, and SpO2, 94% on room air. He is speaking in full sentences and does not appear to be in respiratory distress. He has rales at the right lung base, mild wheezes, and tachycardia. Chest radiograph confirms right lower lobe pneumonia. The patient has no recent hospitalizations. You believe that he looks clinically well and may be able to be discharged home with antibiotics, but you are also concerned for sepsis and wonder if this would be a wise decision...

A 45-year-old man with hypertension and prostate cancer in remission presents complaining of 3 days of burning with urination, fevers, and chills. His vital signs are: heart rate, 110 beats/min; respiratory rate, 20 breaths/min; blood pressure, 130/90 mm Hg; SpO2, 98% on room air; and temperature, 38.4°C (101.2°F). He is alert and fully oriented. His physical exam reveals mild suprapubic tenderness without rebound or guarding and bilateral costovertebral angle tenderness. Lab findings include a WBC count of 18,000 with 5% bands, a creatinine of 1.5 mg/dL, a platelet count of 130 x 103/mm3, 80 WBCs on urinalysis with positive nitrite and leukocyte esterase, and a serum lactate of 1.2 mmol/L. After receiving ibuprofen and a fluid bolus, the patient feels better and states, “I need to go get my dog!” The nurse asks you if she can remove the IV for the patient to be discharged, which sounds reasonable, but something worries you...

 

Product Reviews
Andrew M - 11/20/2018
Great article. Enjoyed the podcast as well. Will change my practice. Thanks!
Abdul M, MD - 11/15/2018
I have gained a better knowledge of sepsis and its management
Marc Z, DO - 11/14/2018
Excellent article. Very much enjoyed comparing the new and old definitions of sepsis. I now have a better understanding of fluid use, as well as special patient populations. Also able to combat our hospital administration with evidence, given that they think any patient that walks into the ER with a fever (with stable everything else) requires full court press care.
Greg H, MD - 11/13/2018
Excellent update. Hard to keep up on the changes. After reading this, I'll perform better physical exams and do more aggressive work ups and will pay more attention to subtle vital sign abnormalities.
Randall S, MD - 11/12/2018
There is a lot of confusion about sepsis. I appreciated the clarification and simplification of the topic in this article.
Hector A., NP - 11/08/2018
This article gave me better evidence-based medicine practices to incorporate into patient care for better outcomes and reduced morbidity/mortality.

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Last Modified: 12/12/2018
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