Image Taken from the FOAMCast Episode

We've discussed SEPSIS a ton on EMCrit.

* Podcast 154 - Preemptive Sepsis Panel SmaccBack

* Wee - Cliff Deutschman with Additional Thoughts on Sepsis 3.0

* Renoresuscitation: Sepsis resuscitation designed to avoid long-term complications

* Podcast 112 - A Response to the Marik Sepsis Fluids Lecture

* Podcast 169 - Sepsis 3.0 with Merv Singer

* Podcast 89 - Lessons from the STOP Sepsis Collaborative

Recently, the Surviving Sepsis Campaign released their 2016 guideline update. Overall, I think this iteration moves the guidelines closer to the best evidence out there. Of course, when you travel that path it forces a divergence from the distinctly non-evidence-based CMS guidelines. In this Practical Evidence Podcast, we will discuss the SSC guidelines, the aforementioned divergence, and various alcohol recommendations. I brought on my buddy, Jeremy Faust, to discuss the changes. Jeremy is 1/2 of the FOAMcast podcast which just discussed the new guidelines in a recent episode.

Guideline Stuff

* The SSC 2016 Guidelines

* PDF Version of the SSC 2016

* Users' Guide to the Guidelines

* Our Emergency Medicine Clinics Article

The Guideline Recommendations

The Definition of Sepsis

They basically ratified SEPSIS 3.0

(Jeremy found where he saw the remnants of the old definition; it was in the Users' guide figure 2--super contradictory)

Fluids

30 ml/kg in the first 3 hours

Crystalloid first, then maybe albumin

Use dynamic markers and/or fluid challenges

Goal MAP>65

EGDT is no longer recommended

Lactate

attempt to normalize lactate

Blood Cultures

get them before antibiotics, if obtaining them will not delay the provision of antibiotics

Antibiotics

Within 1 hour of sepsis or septic shock

Vasopressors

Norepi is the first choice, add in epi or vaso

Do not use dopamine

Steroids

200 mg Hydrocortisone for patients who are still unstable after fluids and vasopressors

Blood

In most circumstances, use a trigger of <7.0 g/dL