emDocs - February 14, 2020 - By Helman A
"Take home points on sepsis and septic shock
- Calculate NEWS to detect subtle cases of occult septic shock.
- Less saline, more Ringer’s, even if acute heart failure, especially in renal failure and severe acidosis.
- Norepinephrine whenever MAP <65 – earlier rather than later.
- Early antibiotics (within 1hr of the diagnosis rather than 1 hour of arrival at ED), given over 5 minutes (except vancomycin over 30 minutes), chosen wisely according to local antibiograms.
- Use a combination of MAP, GCS, urine output, initial lactate, capillary refill time, POCUS IVC to guide initial fluid resuscitation, individualized to each patient.
- If the lactate is rising despite resuscitative efforts call your intensivist. Early to ICU is preferable, but remember that capillary refill time may be as good, or even better than lactate at guiding resuscitation.
- Consider vasopressin and hydrocortisone if a MAP of 65 cannot be maintained with 35mcg/min norepinephrine and ongoing fluid resuscitation."