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Pre-Hospital Antibiotics in Sepsis?

RebelEM

Background: Sepsis remains one of the leading causes of morbidity and mortality. It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Prehospital Administration of Broad-Spectrum Antibiotics for Sepsis Patients: A Systematic Review and Meta-Analysis. Health Sci Rep 2022.

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The Latest in Critical Care, 10/30/23 (Issue #18)

PulmCCM

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

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Tasty Morsels of Critical Care 075 | Vasopressin

Emergency Medicine Ireland

As such vasopresin exhibits the same ADH effects but this maxes out at very low doses, much lower than what we use in sepsis. First up is the VASST trial, (Russel et al 2008 NEJM). Primary outcome here was kidney based rather than mortality. New Engl J Medicine 358 , 877–87 (2008). 400 pts here, no clear benefit for vaso.

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The Latest in Critical Care, 2/5/24 (Issue #28)

PulmCCM

Fever in the ICU: Guideline Update The Society of Critical Care Medicine (SCCM) and the Infectious Diseases Society of America (IDSA) issued an interim update to their 2008 recommendations for the management of fever in the ICU. PulmCCM is not affiliated with SCCM or IDSA. °C oral measured multiple times).

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Diagnostics: Inflammatory Markers

Taming the SRU

A 2008 review in the International Journal of Medicine on spinal epidural abscess (SEA) agreed that inflammatory markers (specifically ESR and CRP) are generally sensitive in the diagnosis of SEA, but are not specific. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear.

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Review of the ATHOS 3 trial

Northwestern EM Blog

The primary outcome of the study was the response in MAP three hours after the start of angiotensin II infusion. It showed improvement in blood pressure which is a clinically important parameter but not a patient-oriented outcome. However, one limitation of the study was that it was underpowered to demonstrate a mortality difference.

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The Latest in Critical Care, 2/12/24 (Issue #29)

PulmCCM

SCCM made its statement unilaterally, without the European Society of Intensive Care Medicine (ESICM), its partner on the 2008 and 2017 updates, or the American Thoracic Society (ATS). That could be because CIRCI is ill-defined, almost hypothetical. The new evidence prompted all three societies to issue new guideline updates.

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