When an ED starts providing advanced care for severe sepsis, lactate testing is an absolute requirement. Lactate use brings up a lot of questions, especially if it is not commonly ordered in your department. In this podcast, I discuss all of the lactate questions that have come up in the course of the NYC Sepsis Collaborative.

For the past few months, I have been co-chairing this NYC-wide sepsis collaborative under the auspices of a hospital organization. 56 hospitals have joined the collaborative with the goal of breaking down the barriers to aggressive sepsis care in the ED.

The protocols and educational materials for the project will always be cross-posted here:

http://emcrit.org/sepsis/

Many of the questions we have been getting relate to the use of lactate as a screen and an indicator of adequate treatment. Last week, I discussed these issues during a webinar. This podcast is the recording of that cast.

Here is the Lactate Reference Sheet

Other important info:

The emcrit webtext is now at crashingpatient.com and the blog has moved to http://emcrit.org

Scott Gallagher sent in the comment regarding commotio cordis as a cause of v-fib/v-tach in trauma patients. He is quite right to point out that ACLS works for these folks. Shock and use anti-dysrhythmics.

Here is a reference from the New England Journal:

NEJM 2010;362:917

Update:

Another article demonstrating the equivalence of arterial and venous lactates (The American Journal of Emergency Medicine  Volume 31, Issue 7, July 2013, Pages 1118–1120)

A review by some of the Lactate Doubters

A balanced perspective on lactate from NEJM [cite source='pubmed']25494270[/cite]

Another article demonstrating the >=4.0 threshold is a good one (10.1097/CCM.0000000000000742)

A small study demonstrates that venous lactate may be even a better prognostic predictor than arterial (Effectiveness of arterial, venous, and capillary blood lactate as a sepsis triage tool in ED patients. Am J Emerg Med. 2014 doi: 10.1016/j.ajem.2014.11.003)