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Congestive Heart Failure and Sepsis: A Closer Look at Fluid Management

RebelEM

For those with sepsis, the administration of intravenous fluids (IVF) at the volumes recommended in the Surviving Sepsis Campaign (SSC) requires careful consideration of an individual’s chronic medical conditions and subsequent sensitivity to IVF. Am J Emerg Med. 2023;73:34-39. The authors searched Embase, PubMed, and Scopus.

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2023 Critical Care Year in Review (Part 1)

PulmCCM

Sepsis, infectious disease Managing septic shock with a restrictive-fluids approach (preferentially using vasopressors after a single liter crystalloid bolus) led to similar outcomes as the usual practice of bolusing large volumes of fluids first. Either approach in severe sepsis with shock seems reasonable.

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A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock

Don't Forget the Bubbles

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. Obviously, one also needs to address the cause of the shock, or any efforts in resuscitation will only bring a temporary improvement. He presented tachycardic and hypotensive with a capillary refill time of 5 seconds.

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Reference ranges of paediatric heart rate and respiratory rate

Don't Forget the Bubbles

Heart rate (HR) and respiratory rate (RR) are THE major vital signs used in Advanced Paediatric Life Support ( APLS) guidance , sepsis guidelines , and Paediatric Early Warning Scores (e.g., Identify the percentage of children whose heart or respiratory rate would exceed the “severe” cut-off from the UK Sepsis Trust and NICE guidelines.

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SGEM#294: Blood Pressure – Do Better, Keep Rising with NorEpi

The Skeptics' Guide to EM

Date: June 2nd, 2020 Reference: Permpikul et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Date: June 2nd, 2020 Reference: Permpikul et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Respir Crit Care Med 2019.

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Non-Invasive Blood Pressure Monitoring in Critically Ill Adults?

RebelEM

were they in the resuscitative phase? were they in the resuscitative phase? This study does not address the utility of arterial lines vs NIBP in the acute resuscitative phase Author Conclusion: “There was broad agreement between IABP and NIBP in critically ill patients over a range of BPs and severity of illness. to 2.47; p – 0.04

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The CLOVERS Trial

Taming the SRU

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. N Engl J Med. 2023;388(6):499-510. 2019, Bauer, Gerlach et al.

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