Podcast Episode 19: Sepsis
If you sit on a patient long enough, infection has a greater chance of taking hold and progressing to sepsis, or you may receive a patient who has already been sick for days. Doc Jabon Ellis walks us through the full spectrum from infection and SIRS to sepsis, shock and death.
Despite firm CoTCCC and ICRC recommendations for early antibiotics, in the past we may have foregone that luxury because of lighting fast evacuation times, maybe even thinking, ‘they’ll take care of it at the next echelon.’ A great medic should not only treat their patient but set them up for success at the next echelon, as sepsis is a testament to how poor care during the TCCC phases of care can cost our patients days and weeks in a hospital later.
But what if you are your own next echelon? Point of injury to Role 1+ could be your own team house or single litter aid station. Go down the checklist on the right side of the PFC trending chart and make sure you are taking care of anything that could result in an infection. Have you given those antibiotics? How is your airway and respiratory care? Did you replace any dirty IV or IO sites you placed in the field? Are you doing all your procedures an as aseptic manner as much as possible? When will you debride? Are you doing everything you can to prevent pressure ulcers?
When will you call for a telemedical consult? When your patient develops a fever? Blood pressure falling? Altered mental status?
Do you know how to dilute your 1:1000 epinephrine to use as a push dose pressor? (It’s in the Tactical Medical Emergency Protocols) Is an Epi drip approriate, why or why not? How much fluid will you give to help prop up that BP? All questions that the medic prepared for PFC should be looking to answer.
If you haven’t already done so, please take our survey on sepsis recognition and management before you watch the episode, then take the quiz at the end to see what you learned.
Now check out the video below or listen on your favorite podcast app:
Or just listen to the audio:
Read the following Sepsis scenario, then take the quiz below:
While on deployment to Democratic Republic of the Congo, a local elderly man came to us complaining of cough, chills, short of breath, feeling very tired for about a week. Since this was the 900th patient I’ve met here with those same symptoms, I didn’t think too much about it and brought him into the clinic. Initial vitals were HR 93, RR 23, BP 106/46, Temp 102.1 F, and SpO2 95% . He was lethargic, but could answer questions. On exam his breathing was shallow, regular, and labored, with coarse crackles in the lower lobes. When I asked him to take a few deep breaths, he coughed thick, nasty, yellow/brown sputum into the mask I had given him to wear. Cardio exam was normal (besides tachycardia), no extra sounds and his skin was warm to the touch in all extremities both distal and proximal, Cap refill less than 2 sec.
TMEPS on Sepsis:
Epi Drip for Sepsis:
Click here for more details on the dirty Epi drip from AliEM.
Doug’s take on what works:
What works in sepsis? Early, appropriate antibiotics (definitely). Early resuscitation targeted to organ perfusion outcomes (maybe). Pressors for septic shock. Steroids for septic shock not responding to pressor w/In 24 hours.
-D
Another excellent podcast! A little bit of a long shot question but has the use of vasopressin been experimented with at all? I can see a major con being with sepsis defined with end organ damage and a major decrease in GFR why would we want to slow it even more by playing with RAAS but angiotensin II being such a powerful vasoconstrictor, I can see potential benefits.
In the video, the provider stated that a decrease in tactile fremitus is a sign of pneumonia. It is actually an increase in tactile fremitus that is most often associated with the type of consolidation seen in some pneumonias. Whereas a decrease in tactile fremitus is most often associated with extra air or fluid. To be fair it really depends on the pattern of pneumonia, and the exam itself is only as sensitive as the provider is experienced.