In this episode, Dr Liu Zhenghong interviews Dr Koh Shao Hui about Sepsis in the ED, including definitions, the Marik and Rivers studies, treatment principles and goals as well as the evidence behind them, and future directions. 

Timestamps:
01:51 Sepsis definitions (SOFA, qSOFA, NEWS, Sepsis 3, Septic shock)

09:37 Treatment principles and goals: Fluid Resuscitation 

11.03 POCUS directed fluid resuscitation & Passive Leg Raise

14:23 Vasopressors in Sepsis

17:57 Time to Antibiotics 

20:29 Steroids in Sepsis 

21:36 Marik & Rivers studies 

25:30 Target Hb/ Glucose control 

28:43 Intubating a septic patient

30:22 (More about) POCUS in septic patients 

33.41 Disposition 

36:21 Future Directions

For more on use of vasopressors in shock, check out Episode 8. Keen listeners may find some differences in nuances across episodes; we strive to represent this diversity and complexity in our field, and encourage listeners to engage with the evidence and contextualise it to their own practice.

References:

1. Evans et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Critical Care Medicine 49(11):p e1063-e1143, November 2021. 
2. Bannard-Smith J et al. The efficacy, safety and effectiveness of hyperoncotic albumin solutions in patients with sepsis: A systematic review and meta-analysis. J Intensive Care Soc. 2024;25(3):308-318. 
3. Deng J et al. Efficacy and Safety of Hydrocortisone, Ascorbic Acid, and Thiamine Combination Therapy for the Management of Sepsis and Septic Shock: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Int Arch Allergy Immunol. 2024;185(10):997-1018. 
4. Fernando SM et al. Methylene Blue in Septic Shock: A Systematic Review and Meta-Analysis. Crit Care Explor. 2024;6(7):e1110.
5. Killu K et al. The association between integrating echocardiography use in the management of septic shock patients and outcomes in the intensive care unit: a systematic review and meta-analysis. J Ultrasound. 2024 Oct 17. 

Credits: 

Music: Life-line by Colorful Sound via Pixabay

SGH Podcast Studio

SEMS 

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