#FOAMcc

In 2002, a new standard of care was established when the Surviving Sepsis Campaign (SSC) highlighted the importance of recognizing sepsis and initiating treatment early. Once we find that a patient meets Systemic Inflammatory Response Syndrome (SIRS) criteria with a source of infection, rapid and appropriate treatment including resuscitation is a must. Early fluid resuscitation is necessary for septic patients, but there is large variance on the aggressiveness of fluid resuscitation. There is disagreement amongst the experts on the total amount of fluids that should be administered and the end points for resuscitation. We must ask ourselves, at what point does our aggressive resuscitation actually start to harm our patients?

Does your choice of fluids for resuscitation in sepsis matter? Multiple studies have been performed to determine whether septic patients benefit from colloid versus crystalloid IV fluids, and other studies have specifically looked at the different kinds of fluids within those specific groups. Debate now exists as to which fluid will improve patient outcomes.

A great deal of literature exists on sepsis and providing state of the art care in the ED. As EM physicians, we pride ourselves on resuscitating sick patients, and we are well aware that septic patients can rapidly decline clinically. Finding the source and providing appropriate antibiotics, adequate preload with IV fluids, and vasopressors if necessary are key components. The SIRS criteria are our first line of defense in the early identification of sepsis. But, it is important to recognize that just because a patient has multiple SIRS criteria, they may not actually be septic.

Are there any tests that can help you with Giant Cell Arteritis?

A power review of the literature on management of blunt and penetrating abdominal trauma

Continuous quantitative waveform capnography, also known as end-tidal carbon dioxide, PetCO2, or ETCO2, is a measurement of the partial pressure of CO2 in the exhaled breath. This technology has been around since the mid-19th century and only relatively recently has its potential in emergency medicine begun to be explored. […]

Sepsis is the most common cause of death in children worldwide. What is the optimal evaluation and management of pediatric sepsis?

Included below is a summary of numerous blog posts and podcasts that discuss the sometimes controversial issue of permissive hypotension or minimum volume resuscitation in the bleeding trauma patient.

The Basics

• Idea of keeping BP low in traumatic hemorrhage to avoid “popping the clot”
• Based mostly on data from animal trials and penetrating trauma in humans
• Common practice in most major trauma centers in USA
• The exact approach still remains controversial around the world

Disclaimer: These are highlights as interpreted by the author of this article and should not replace listening to the original podcast or reviewing the background research.  Posts are in chronological order and many of the below podcasts go beyond the scope of permissive hypotension. […]

Does End Tidal CO2 correlate with PaCO2 in Traumatic Brain Injury?

Your neurosurgeons and trauma team have accepted a transfer to your hospital for intensive management of a trauma patient who presented to a small community hospital with a traumatic subarachnoid hemorrhage and epidural hematoma after being involved in a motorcycle accident.

While the patient is in the ED, the neurosurgeons recommend maintaining eucapnea for the patient since while there are no acute signs of herniation.(1)

Can you use the end tidal CO2(etCO2) or do you need to rely on arterial blood gas (ABG) measurements to maintain PaCO2 between 35-40 mm Hg? […]