This is the podcast, ICU rounds. My name's Jeff Guy. I'm an associate professor of surgery at Vanderbilt University Medical Center, Director at the Burns Center there.

The topic for this discussion is sepsis part two. Several weeks ago, we released a podcast on sepsis part one, where we went into some of the introduction of what are the definitions of

sepsis, what's some of the biochemical etiology of sepsis, and what are some of the statistics.

We delved into some of the pathophysiology as well as some of the cellular mechanisms which

actually make the septic patients sick. Today I like to actually kind of focus on what are some

of the hemodynamic resuscitation guidelines and how we go about resuscitating these patients

and what are some of the medications that we use to try to normalize some of the abnormal

cardiovascular physiology. You know somebody has sepsis from pneumonia. We're not going to focus so much on

the treatment of the pneumonia, but how do we go about treating the abarred physiology? You remember

from the first talk, we said that sepsis, you know, it's kind of like jumping out of an airplane.

It's not the fall that kills you, but the sudden stop. And a lot of times with sepsis, again, it's not the infection that is, that is killing

the patient, but it's the patient's physiological response to that infection. And then we talked

about the campfire in the forest and issues of source control. And that, you know, if you imagine that a parent and iders or pneumonia is the campfire

and a hot ember gets out and sets the forest on fire, then that's the issue of sepsis.

How do we control that inflammatory response?

Now, it's important to keep in mind that shock is not defined by a particular blood pressure.

Shock is defined by running oxygen debt.

Now having said that, you can have patients who have low blood pressures and have adequate oxygen delivery to the peripheral tissues,

or you get a patients who have elevated blood pressures and have decreased or depressed auction delivery.

When you have depressed auction delivery, cells don't function well, cells don't function

well, tissues don't function well, tissues don't function well, organs don't function well,

they fail and that results in death.

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