Sepsis (Deep Dive R18)

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9 • 816 Ratings

🗓️ 16 February 2021

⏱️ 13 minutes

🔗️ Recording | iTunes | RSS

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Summary

Four definitions you must know:

* SIRS – Must have at least 2 of 4 SIRS criteria (listed below):* Fever (>38C) or Hypothermia (<36C)* WBC >12k or <4k ; OR Bandemia >10%* Tachycardia > 90* Tachypnea > 20* SEPSIS – Must have SIRS + have a suspected infectious source (eg pulmonary, urinary, intra-abdominal, etc)* SEVERE SEPSIS – Must have Sepsis + ONE of the following criteria indicative of end organ dysfunction:* Hypotension (MAP<65 or SBP<90)* Creatinine > 2.0 (with normal baseline renal function)* Lactate > 2.0* Platelets < 100k* INR > 1.5* Bilirubin > 2* SEPTIC SHOCK – Must have severe sepsis PLUS one of the following* Hypotension DESPITE adequate fluid resuscitation (usually 30cc/kg bolus)* Lactate > 4.0 DESPITE adequate fluid resuscitation (usually 30cc/kg bolus)

GENERAL GUIDELINES (exact management depends on clinical scenario):

* If patient meets SIRS criteria you work the patient up for sepsis / severe sepsis:* Lactate, Blood Cultures, Urinalysis/Culture, Chest XRay* CBC, BMP, Coags, LFTs* If patient meets SEPSIS criteria, you add in broad spectrum antibiotics +/- intravenous fluids* If patient meets SEVERE SEPSIS criteria, you give a 30cc/kg fluid bolus,* If patient meets SEPTIC SHOCK criteria and is HYPOTENSIVE, you start vasopressors (norepinephrine usually)

MDCalc – Sepsis

Sepsis-2 and Sepsis-3 Guidelines Summarized

Transcript

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0:00.0	Hello, students and residents. My name is Mike Estefan, and I thank you for joining me today on this episode of the EM Clerkship Podcast.
0:12.2	As Zach alluded to during our last episode, this is the first episode of the bonus educational content that we are going to be putting out to supplement our
0:22.5	monthly oral board cases. The goal of these bonus episodes is to dive deeper into topics
0:29.1	that I was tested on during the preceding episode of the game. Before we begin, I want to give
0:36.2	a short plug to our sponsor, Pearson Rabbits.
0:39.3	As you probably can recall from recent episodes, Pearson Rabbits is a company that specializes in disability insurance for physicians, including both residents and attendings.
0:51.3	Let me share a quick story with you guys. This happened just two and a half
0:56.1	weeks ago to me. I was bouldering at my favorite climbing gym when I unexpectedly fell from the top
1:02.5	of the climbing wall and landed on my right wrist. And for reference, I'm right-handed. It hurt,
1:08.9	but I didn't think too much of it until later that night.
1:11.6	The same night after the fall, I went into my overnight ED shift, where I had to physically
1:17.0	restrain a combative hypoxic overdose patient who we had just pushed some IV Narcan on.
1:23.7	In the process of doing so, my wrist pain went from just a twinge to excruciating.
1:29.3	I was sure that I had fractured something.
1:31.3	It was so bad that after my ED shift, I checked myself into the ED to get an X-ray and get splinted.
1:38.3	After talking with occupational health, I learned that I would not be allowed to work clinically with a splint,
1:45.5	as it violates hand hygiene protocols, and that I would need to take disability leave if the
1:50.8	splints was medically necessary. Luckily, after an urgent appointment with sports medicine
1:55.5	and a stat MRI, it was determined that my injury did not require splinting at work and I was allowed to return to work.
2:04.0	I'm telling you guys this story because it was my wake-up call for how valuable and necessary disability insurance is.
2:10.9	I'm an otherwise healthy 29-year-old male who just prior to this was planning on signing up for disability insurance right before graduating
2:18.9	residency just to lock in the lower rates. I thought to myself that nothing would happen,
	...

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