sepsis

You are in the midst of caring for a 62 year-old male who is tachycardic with HR 120, BP 88/42, T 101.2 oF, RR 26, and SpO2 98%. He was brought in by EMS for fever and myalgias, and with one look at his vital signs, he triggered the protocol for SIRS.

Your initial exam showed similar vital signs, with dry mucous membranes but otherwise normal HEENT exam, clear lungs, normal mental status, nontender abdomen, normal skin and genitourinary exams, and normal extremities/back. Due to his vital signs and SIRS criteria, you were concerned and ordered CBC, RFP, LFT, lactate, blood cultures, urinalysis/culture, and chest xray. You started 1 L NS, and his VS did not improve.

“Beta blockers may improve hemodynamics, organ preservation, pressor requirements, and mortality”

Is there a role for beta blockade in septic patients? It seems counterintuitive, but Cynthia Santos, MD presents some recent literature suggesting a benefit in an ICU setting.

“Some have questioned exactly which parts of the bundle are beneficial, which parts are not, and which parts may be causing harm”

Steven Whelpley, DO reviews the recent literature on sepsis recognition and treatment in the ED.