Why do we care about sepsis in prolonged field care? What can we do about septic shock with what we are normally carrying on a deployment? How do you mix an epinephrine drip? Dr. Maves lays it all out in about 20 minutes.
Here are some of the resources and pearls he mentioned in the episode:
- Infection plus organ dysfunction is sepsis
- Infection plus hypotension is septic shock
- Q-SOFA positive with 2 of the three and suggestive of sepsis:
- Systolic BP <100
- RR>22 breaths per minute
- Presence of delirium
- Earlier intervention is better than later
- Higher mortality rate than poly trauma or myocardial infarction
- Something is better than nothing
- Septic shock is not purely distributive. You will also see myocardial depression loss of contractility, capillary leakage, microvascular obstruction from small thrombi and concomitant hypovolemia.
- Some fluids are good but more fluids mat be dangerous
- If 2 or 3 liters does not work it is unlikely that 5 or 6 fix hypovolemia. At some point it will start increasing mortality.
- The best vasopressor is the one you have
- Delaying proper antibiotics increases risk of death by 8% every hour.
IMAI district clinician manual: Hospital care for adolescents and adults…
Now on to the podcast…