Practical Considerations in Sepsis Resuscitation.

MedStar author(s):
Citation: Journal of Emergency Medicine. 52(4):472-483, 2017 AprPMID: 27823892Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Resuscitation/mt [Methods] | *Sepsis/pp [Physiopathology] | *Sepsis/th [Therapy] | Anti-Bacterial Agents/pd [Pharmacology] | Anti-Bacterial Agents/tu [Therapeutic Use] | Emergency Service, Hospital/og [Organization & Administration] | Fluid Therapy/mt [Methods] | Hemodynamics/de [Drug Effects] | Humans | Sepsis/co [Complications] | Shock, Septic/di [Diagnosis] | Shock, Septic/pp [Physiopathology] | Vasoconstrictor Agents/pd [Pharmacology] | Vasoconstrictor Agents/tu [Therapeutic Use]Year: 2017Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:
  • 0736-4679
Name of journal: The Journal of emergency medicineAbstract: BACKGROUND: Sepsis is a common condition managed in the emergency department, and the majority of patients respond to resuscitation measures, including antibiotics and i.v. fluids. However, a proportion of patients will fail to respond to standard treatment.CONCLUSIONS: The care of sepsis has experienced many changes in recent years. Care of the patient with sepsis who is not responding appropriately to initial resuscitation is troublesome for emergency physicians. This review provides practical considerations for resuscitation of the patient with septic shock. When a septic patient is refractory to standard therapy, systematically evaluating the patient and clinical course may lead to improved outcomes.Copyright Published by Elsevier Inc.DISCUSSION: Early goal-directed therapy revolutionized sepsis management. However, there is a paucity of literature that provides a well-defined treatment algorithm for patients who fail to improve with therapy. Refractory shock can be defined as continued patient hemodynamic instability (mean arterial pressure, < 65 mm Hg, lactate > 4 mmol/L, altered mental status) after adequate fluid loading (at least 30 mL/kg i.v.), the use of two vasopressors (with one as norepinephrine), and provision of antibiotics. When a lack of improvement is evident in the early stages of resuscitation, systematically considering source control, appropriate volume resuscitation, adequate antimicrobial coverage, vasopressor selection, presence of metabolic pathology, and complications of resuscitation, such as abdominal compartment syndrome and respiratory failure, allow emergency physicians to address the entire clinical scenario.OBJECTIVE: This review elucidates practical considerations for management of sepsis in patients who fail to respond to standard treatment.All authors: Koyfman A, Long B, Modisett KL, Woods CJFiscal year: FY2017Digital Object Identifier: Date added to catalog: 2017-05-06
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 27823892 Available 27823892

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

BACKGROUND: Sepsis is a common condition managed in the emergency department, and the majority of patients respond to resuscitation measures, including antibiotics and i.v. fluids. However, a proportion of patients will fail to respond to standard treatment.

CONCLUSIONS: The care of sepsis has experienced many changes in recent years. Care of the patient with sepsis who is not responding appropriately to initial resuscitation is troublesome for emergency physicians. This review provides practical considerations for resuscitation of the patient with septic shock. When a septic patient is refractory to standard therapy, systematically evaluating the patient and clinical course may lead to improved outcomes.

Copyright Published by Elsevier Inc.

DISCUSSION: Early goal-directed therapy revolutionized sepsis management. However, there is a paucity of literature that provides a well-defined treatment algorithm for patients who fail to improve with therapy. Refractory shock can be defined as continued patient hemodynamic instability (mean arterial pressure, < 65 mm Hg, lactate > 4 mmol/L, altered mental status) after adequate fluid loading (at least 30 mL/kg i.v.), the use of two vasopressors (with one as norepinephrine), and provision of antibiotics. When a lack of improvement is evident in the early stages of resuscitation, systematically considering source control, appropriate volume resuscitation, adequate antimicrobial coverage, vasopressor selection, presence of metabolic pathology, and complications of resuscitation, such as abdominal compartment syndrome and respiratory failure, allow emergency physicians to address the entire clinical scenario.

OBJECTIVE: This review elucidates practical considerations for management of sepsis in patients who fail to respond to standard treatment.

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