So the three of us are back together and going to take on Sepsis!
It's vital to have a sound understanding of sepsis. It has a huge morbidity and mortality but importantly there is so much that we can do both prehospital and in hospital to improve patient outcomes.
In the podcast we cover the following;
We hope the podcast helps refresh your knowledge on the topic and brings about some clarity on some contentious points. As always don't just take our word for it, go and have a look at the primary literature referenced below.
Enjoy!
Trial of early, goal-directed resuscitation for septic shock. Mouncey PR. N Engl J Med. 2015
NICE; Sepsis: recognition, diagnosis and early management
NHS E; Improving outcomes for patients with sepsis. A cross-system action plan
Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. Venkatesh B. N Engl J Med. 2018
PHEMCAST; End Tidal Carbon Dioxide
Current clinical controversies in the management of sepsis. Cohen J. J R Coll Physicians Edinb. 2016
RCEM; Severe Sepsis and Septic Shock Clinical Audit 2016/2017 National report
On a not infrequent basis we will come across patients in hospital who have a CT head scan that appears to show an unsurvivable event. Having sourced opinion from our neurosurgical and neurology colleagues we may well be given the advice to withdraw care for the patient.
It has become increasingly recognised that prognosticating in such patients at an early stage is extremely difficult with numerous cases surviving what was initially thought to be an unsurvivable event, with a good neurological outcome.
This joint document from the Intensive Care Society, Royal College of Emergency Medicine, Neuro Anaesthesia and Critical Care Society of Great Britain & Ireland and the Welsh Intensive Care Society gives new guidance for such perceived devastating brain injuries and will challenge many peoples thinking on the topic with additional questions being asked on resource utilisation.
In this podcast Caroline Leech, EM and PHEM Consultant in Coventry, discusses the guidelines and the implications they hold for our practice.
As always make sure you read the document yourself, we would love to hear your thoughts.
Enjoy!
Management of Perceived Devastating Brain Injury After Hospital Admission; A consensus statement
Welcome back, we've got 3 absolute beauties of papers for you this month!
You'll have struggled not to have heard about the ADRENAL trial, a trial of iv steroids in the sickest of patients with septic shock. We also have a look at a trial that many have been quoting as sound evidence for the utility of pH during the prognostication of patients in cardiac arrest. Finally we have a look at a paper that may shed some concern on the use of Double Sequential Defibrillation that we covered recently on the podcast...
We'd love to hear from you with any thoughts or feedback you have on the podcast. And we've now launched of Critical Appraisal Lowdown course, so if you want to gain some more skills in critical appraisal make sure you go and check out our online course here.
Enjoy!
Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. Venkatesh B. N Engl J Med. 2018