Podcast Episode 50: Simple Sepsis Recognition and Intervention for Prolonged Field Care

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…

WHO Sepsis First 2 HoursWHO Sepsis Hours 2-6WHO Sepsis Hours 6-24WHO Sepsis Post ResuscitationWHO Sepsis Vasopressors

For more Download the World Health Organization Manual for Integrated Management of Adolescent and Adult Illness:

WHO IMAI Manual


Download Volume 2 of the WHO IMAI:

WHO IMAI Vol 2


Now on to the podcast…

3 thoughts on “Podcast Episode 50: Simple Sepsis Recognition and Intervention for Prolonged Field Care”

  1. Good Day, I noticed during the podcast a quote of Sepsis having a higher mortality rate than polytrauma or MI. I didn’t know this and would like to read more can you all point me in the direction to find this study or reference?

  2. I think the shorter podcast is a good idea. Attention spans usually last about 15 minutes anyway (good Mike Lauria talk). EMcrit and FlightBridgeEd Podcasts follow this model.

    This was a great podcast. What I have listened to and read about managing sepsis has mostly been within the CONUS and using CONUS support. It was great to hear current best practices in the context of PFC.

    Perhaps you guys can comment on this further but as the podcast was playing, my mind when to Hetastarch as a possible adjunct to crystalloids. I did a little research and found several studies advising against the use of hydroxyethyl starches (Hextend being one) and their use and the FDA issuing a black box warning against its use and possible nephrotoxicity an increased risk of bleeding. In reading these studies though, I do not see where it specifies the time period the HES’s were administered. Was it given initially to help with SBP or was it given over the course of the ICU stay (rhetorical)? I could not find this. In the PFC environment, it may be hours to days before evacuation.

    What is your take on using Hextend for this short period of time for s/s of lack of organ perfusion?

    Thanks,

    1. Treatment with the fluid you have is always my opinion. Are there better choices than hetastarch? Umm yeah, but if that is all you have and the patient doesn’t have the mental status to drink water, or the rectal route is not an option, then I guess the patient’s best chance would be to use it. Just my opinion though.

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