Sepsis Review- Dr Shoff

What is sepsis? A systemic response to infection
Mortality reduction in sepsis? ANTIBIOTICS EARLY
SIRS- T 101F/90, RR >20, WBC >12k/10% bandemia with evidence of End Organ Dysfx
Severe sepsis += hypoperf despite adequate IVF resus.-30ml/kg crystalloid, or a drop in SBP drop by 40 mmhg, or any SBP <90mmHg
What do you do?
Within 3h of presentation get:
1. Lactic
2. Blood cx BEFORE abx
3. Broad spec abx coverage=zosyn, cefepime, meropenem, ceftriaxone, unasyn, amp, levofloxacin

Within 6h

Within 6h, rep lactic in first is >2h.
Pressor if ivf persist
If lac >4h rept vol status and tissue assessment
If hypotensive after ivf, repeat vol status and tissue assessment.

TIssue assessment/vol assessment?
Vs
Cardiopulm exam
Cap refill
Peripheral pulse eval
Skin exam

Exclusion crit
Comfort care
Death within 6h
Transfers from osh
Refusal to care

How do we do?
-90% bundle compliance

MCC of sepsis @UofL:
PNA
UTI
Skin/soft tissue

MEWS-used as a trend, if trending up=patient getting sick
Patient with BMI >30, can use Ideal Body Weight for fluid resuscitation

Things I wish I knew in residency-Dr. Gall

Eval where you want to work-shadow, see how RNs interact with staff
Less than 12h shifts are optimal
Overlap at shift change is beneficial
Nocturnists work less shifts, more $/hr
Negotiate your contract! -no malpractice without tail
$$- invest in broad index fund if you’re gonna play the market
Live below your means-work bc you want to, not because you have to
Keep studying
You will keep getting better
Fly or ground? >1h and critical (will need immediate intervention)= fly–but is dangerous
If issue with a consultant, have them come see the patient or admit patient for obs
Know what chain of command is before your have an issue with c/s
When pacing, consider use of u/s to ensure that you are actually getting capture.
Callback if concerned about a patient
Be nice to your patients
Review your patient prior to dc!
Take care of those you work with!
Apologize-to staff, patients
Books he likes -Rosen’s, EKGs for ER docs by Brady and Mattu, Roberts and Hedges procedure book

Panel

Things to learn before you finish residency-

TPA- talk to stroke team/follow pts whilst here because you’ll have to do it once done here
Chest tubes- percutaneous are more common outside of trauma centers
Ultrasound guided IVs, midlines
Lower acuity/urgent care style cases- we don’t see many here but you will later
It is normal for confidence to wax/wane right out of residency-but this gets better! Trust your training, you have been well trained
Don’t be afraid to call the children’s hospital for advice, not just for transfers
Follow up on patients you saw

Finances-
Pay quarterly taxes if IC
Read white coat investor
Live below your means