The Surviving Sepsis Campaign guidelines have been updated. Some of the highlights include (abstract):
- Initial fluids with crystalloids at 30cc/kg, with goal in first 6 hours of CVP 8-12mmHg, MAP>65 mmHg, and urine output >0.5cc/kg/hr;
- Antibiotics within 1 hour
- No steroids unless refractory shock and no RBC transfusions unless Hb<7
- Vasopressor of choice is norepinephrine with epinephrine added if needed, phenylephrine only with arrhythmias, if cardiac output is high with low BP, or as salvage therapy, and dobutamine for myocardial dysfunction or continued hypoperfusion.
by Deepak Asudani, MD, MPH, FHM Whether it is the prompt and expeditious international collaboration to develop an Ebola vaccine, or tardy but promising development of the first anti parasitic malarial vaccine or the fascinating technology utilizing synthetic DNA for vaccine development against MERS, these developments promise to highlight significant strides in vaccine development for […]
Economists describe preferences in two ways: revealed and stated. Say, for example, I asked you to implement a penalty program for your team with the goal of decreasing the number of occasions members did not clean their hands after a patient encounter. Because you know bad hands equal bad outcomes, you’re apt to offer up […]
by Eric Howell, MD, SFHM “Tell me what you know about antibiotics.” That’s the discussion I start with hospitalized patients all the time, right after they ask me to prescribe antibiotics for their simple cough, or other viral-like illness. And, from their perspective, asking for antibiotics makes sense. After all, antibiotics have been the physician’s […]