Monday, May 17, 2010
Early Goal Directed Treatment of Sepsis
I recently had the privilege of attending the Warren Wetzel Trauma/Emergency Medicine Conference at Jacobi Medical Center (The Bronx, New York). The keynote speaker was Emanuel Rivers M.D. who published "Early Goal Directed Therapy of Severe Sepsis and Septic Shock" in the New England Journal of Medicine in November of 2001. This paper has had a tremendous impact on the field of Emergency Medicine and hearing Dr. Rivers speak of his path to bringing ICU principles into the Emergency Department was an amazing experience.
A few Highlights:
1.) Get a lactic acid level early (levels >4 worrisome for sepsis)
2.) Volume resuscitate heavily early on, and more conservatively later (This will decrease IL-8 production)
3.) Use the venous oxygen saturation to monitor the progress of resuscitative measures
4.) The methods the paper outlines serve to decrease incidence of multi-organ failure, mortality, and the unnecessary use of intensive care resources
Make sure you check it out for yourself and see how you can integrate it into your practice if you have not already done so. It is a valuable for the pre-septic patient anywhere (outpatient, inpatient, pre-op, post-op, etc.) This will make a difference in saving lives with style (just like Dr. Emanuel Rivers). Thank you for the inspiration!
"Early Goal Directed Therapy of Severe Sepsis and Septic Shock" in the New England Journal of Medicine in November of 2001
Surviving Sepsis Campaign