Thank you Dr Erin Narewski for a shocking lecture!
- Start antibiotics within one hour of recognition of severe sepsis or septic shock. Remove any lines or debride any tissue which may serve as a source.
- Initial resuscitation efforts
- CVP 8-12mmHg, MAP >65, Urine output >0.5 mL/kg/hr, Central venous or mixed venous oxygen sat 70 or 65%, respectively.
- Patients with elevated lactate levels targeting resuscitation to normalize lactate
- Transfusion goal of >7 g/dL in those without other circumstances (MI, severe hypoxemia, acute hemorrhage, ischemic heart disease).
- Transfuse platelets with counts <10,000 in absence of bleeding. Prophylactic platelets when counts <20,000 with significant risk of bleeding. Counts greater than 50,000 when active bleeding is occurring, surgery or invasive procedure are planned.
- Glucose goal <180 mg/dL. Be wary of point-of-care testing of capillary blood (maybe falsely low)
- Do not use sodium bicarbonate in patients with hypoperfusion induced lactic academia with pH >7.15
- Vasopressor therapy is to target a MAP of 65mmHg. Norepinephrine is the first choice, followed by epinerphine.
- Discuss goals of care and prognosis with patients as early as is feasible.