recent articles

practice updates

Sepsis Biomarkers: What’s New?

Sepsis is a common disease, but sometimes, we need some assistance with the diagnosis and resuscitation of these patients. Can biomarkers help us, or are we wasting time using these measures? What's wrong with just the time-honored history and exam?

practice updates

The Controversies of Corticosteroids in Sepsis

Sepsis is a condition emergency providers manage daily and has the potential for high morbidity and mortality. Sepsis management requires rapid diagnosis, early administration of intravenous (IV) fluids with broad-spectrum antimicrobials, and source control. But what is the role for steroids in sepsis? What are the potential benefits and risks? This post will explore the evidence surrounding corticosteroids in sepsis management to help shed some light on this controversial topic.

FOAMED

Unstable Sepsis: Airway First? Not Always

Intubation, especially in the septic and critically ill patient, can, by itself, cause hemodynamic abnormalities and/or hypoxemia and hypercapnea. In some situations, it may be important to make sure that the patient is adequately prepared for intubation, both from hemodynamic and pre-oxygenation standpoints. This is a brief review of some suggestions when intubating the very ill patient in the emergency department.

practice updates

Occult Sepsis in Traumatic Injuries

Trauma patients require systematic resuscitation and definitive treatment. However, there are sometimes underlying reasons for the injury, such as syncope prior to the injury or even an underlying infection that made him or her prone to injury. Not all trauma patients will be unstable from their injury and they may have underlying comorbidities that need to be uncovered and treated. This article reviews some basic steps that can be taken to evaluate for underlying infection in trauma patients.

perspectives

Dr. Strangelove or How I Learned to Stop Worrying and Sit on the qSOFA: A pathophysiologic approach to qSOFA

The last few months have seen an enormous amount of controversy in the press, in the FOAMsphere, and in our ED hallways regarding the new consensus sepsis definition. The goal of this post is not to rehash the strengths and weaknesses of Sepsis 3, but rather to explore the pathophysiologic basis of the simplified clinical features of sepsis outlined in the qSOFA score, which might explain why the definition shook out the way it did. Hopefully, such an understanding will help us apply lessons learned from the derivation of Sepsis 3 to the management of these profoundly sick patients.

practice updates

The Dangers of Over-Resuscitation in Sepsis

In previous discussions, we have addressed that IV fluid choices affect patient outcomes in septic shock, and we have shown the evidence that invasive monitoring coupled with aggressive treatments are actually harming our patients. The question we now face is what is the result of over-resuscitation?

In the Literature

Blood cultures: when do they make a meaningful impact on clinical care?

Bacteremia affects 200,000 patients per year, with the potential of causing significant mortality. Blood cultures are considered the most sensitive method for detecting bacteremia and are commonly obtained in patients with fever, chills, leukocytosis, focal infections, sepsis, or suspected endocarditis. However, what is the literature behind obtaining cultures in the ED?