This document summarizes the 2016 guidelines from the Surviving Sepsis Campaign for the management of severe sepsis and septic shock. It outlines recommendations for initial resuscitation with IV fluids, vasopressors, corticosteroids, antibiotics, source control, blood products, glucose control, and bicarbonate therapy. The guidelines emphasize early recognition and treatment, with IV fluids, broad-spectrum antibiotics within 1 hour, and measuring lactate and targeting MAP of 65 mmHg as priorities in initial resuscitation of sepsis and septic shock.
The recent definition, concept and terminologies of septic shock, surviving sepsis campaign, management techniques, SOFA score. Also includes antibiotics and supportive modalities.
It includes new definition, pathophysiology, management of sepsis, septic shock and neutropenic sepsis and even newer evolving concepts or types of sepsis.
The recent definition, concept and terminologies of septic shock, surviving sepsis campaign, management techniques, SOFA score. Also includes antibiotics and supportive modalities.
It includes new definition, pathophysiology, management of sepsis, septic shock and neutropenic sepsis and even newer evolving concepts or types of sepsis.
This talk covers the most important aspects of treatment of acute ischemic stroke, such as thrombolysis, use of antiplatelets, BP and sugar control and general supportive care.
Renal Replacement Therapy: modes and evidenceMohd Saif Khan
Renal replacement therapy is a supportive care often required in critically ill patients who develop acute renal failure and its complications. Complexity arises when such patients become hemodynamically unstable and pose special challenge to critical care clinicians in ICU to carefully choose dialytic modality to tackle volume and solute overload. This presentation is about short description of modalities of RRT and current evidence regarding initiation, dose and type of modality.
Updated global adult sepsis guidelines, released in October 2021 by the Surviving Sepsis Campaign (SSC), place an increased emphasis on improving the care of sepsis patients after they are discharged from the intensive care unit (ICU) and represent greater geographic and gender diversity than previous versions.
The new guidelines specifically address the challenges of treating patients experiencing the long-term effects of sepsis. Patients often experience lengthy ICU stays and then face a long, complicated road to recovery. In addition to physical rehabilitation challenges, patients and their families are often uncertain how to coordinate care that promotes recovery and matches their goals of care.
A very simple yet comprehensive presentation to understand the concept of CRRT and its implementation in Intensive Care Unit. Intended for the very beginners in ICU. After going through the presentation you will be able to say "Now I know it!"
This talk covers the most important aspects of treatment of acute ischemic stroke, such as thrombolysis, use of antiplatelets, BP and sugar control and general supportive care.
Renal Replacement Therapy: modes and evidenceMohd Saif Khan
Renal replacement therapy is a supportive care often required in critically ill patients who develop acute renal failure and its complications. Complexity arises when such patients become hemodynamically unstable and pose special challenge to critical care clinicians in ICU to carefully choose dialytic modality to tackle volume and solute overload. This presentation is about short description of modalities of RRT and current evidence regarding initiation, dose and type of modality.
Updated global adult sepsis guidelines, released in October 2021 by the Surviving Sepsis Campaign (SSC), place an increased emphasis on improving the care of sepsis patients after they are discharged from the intensive care unit (ICU) and represent greater geographic and gender diversity than previous versions.
The new guidelines specifically address the challenges of treating patients experiencing the long-term effects of sepsis. Patients often experience lengthy ICU stays and then face a long, complicated road to recovery. In addition to physical rehabilitation challenges, patients and their families are often uncertain how to coordinate care that promotes recovery and matches their goals of care.
A very simple yet comprehensive presentation to understand the concept of CRRT and its implementation in Intensive Care Unit. Intended for the very beginners in ICU. After going through the presentation you will be able to say "Now I know it!"
The European Guideline on Management of Major Bleeding and Coagulopathy Follo...Sun Yai-Cheng
The European Guideline on Management of Major Bleeding and Coagulopathy Following Trauma: Fourth Edition
Rossaint et al. Critical Care (2016) 20:100
DOI 10.1186/s13054-016-1265-x
ACEP Policy for Fever Infants and Children Younger than 2 Years of Age in EDSun Yai-Cheng
Clinical Policy for Well-Appearing Infants and Children Younger Than 2 Years of Age Presenting to the Emergency Department With Fever
Ann Emerg Med. 2016;67:625-639
Presentación sobre definiciones, etología, fisiopatología, cuadro clínico, diagnostico y tratamiento actualizados según los datos de JAMA 2016 y Surviving Sepsis 2016.
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection.The definition of sepsis was updated in 2016 following publication of the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). This recommended that organ dysfunction should be defined using the Sequential (or Sepsis-related) Organ Failure Assessment (SOFA) criteria or the "quick" (q)SOFA criteria.
Management of Heart Failure in the ED Setting:
An Evidence-Based Review of the Literature
J Emerg Med, 2018 Sep 26.
doi: 10.1016/j.jemermed.2018.08.002
Diffusion-weighted imaging or computerized tomography perfusion assessment with clinical mismatch in the triage of wake up and late presenting strokes undergoing neurointervention with Trevo (DAWN) trial methods
Int J Stroke. 2017 Aug;12(6):641-652.
Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct
N Engl J Med. 2018 Jan 4;378(1):11-21.
A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3)
Int J Stroke. 2017 Oct;12(8):896-905.
Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging
N Engl J Med. 2018 Feb 22;378(8):708-718.
2015 AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment
Stroke. 2015;46:3020-3035.
With the Proliferation of Mobile Medical Apps, Which Ones Work Best in the Emergency Department?
Annals of Emergency Medicine, August 2015 Vol. 66, Issue 2, A13–15
Use of tPA for the Management of Acute Ischemic Stroke in the ED: ACEP PolicySun Yai-Cheng
ACEP Clinical Policy
Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department
Ann Emerg Med. 2015;66:322-333
Evaluation and Management of Acute Aortic Dissection: ACEP PolicySun Yai-Cheng
ACEP Clinical Policy
Evaluation and Management of Adult Patients With Suspected Acute Nontraumatic Thoracic Aortic Dissection
Ann Emerg Med. 2015;65:32-42
C-Spine Collar Clearance In The Obtunded Adult Blunt Trauma PatientSun Yai-Cheng
Cervical Spine Collar Clearance In The Obtunded Adult Blunt Trauma Patient A systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma
J Trauma Acute Care Surg. 2015;78: 430-441.
ASA Guidelines for Management of the Difficult AirwaySun Yai-Cheng
Practice Guidelines for Management of the Difficult Airway
An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway
Anesthesiology 2013; 118(2):251-270
2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: Executive Summary
Circulation. published online September 23, 2014
ACEP Clinical Policy
Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Seizures
Ann Emerg Med. 2014;63:437-447.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. MANAGEMENT OF SEVERE SEPSIS
Management of Severe Sepsis
Initial
Resuscitation Diagnosis Antibiotic
Therapy
Source
Control
Fluid Therapy Vasopressors
Corticosteroids Blood Product
Glucose
Control
Bicarbonate
Therapy
4. Initial Resuscitation
Sepsis and septic shock are medical
emergencies, and we recommend that
treatment and resuscitation begin immediately
(best practice statements, BPS).
In the resuscitation from sepsis-induced
hypoperfusion, at least 30 mL/kg of IV
crystalloid fluid be given within the first 3 h
(strong recommendation, low quality of
evidence).
5. Initial Resuscitation
Following initial fluid resuscitation, additional
fluids be guided by frequent reassessment of
hemodynamic status (BPS).
Remarks Reassessment should include a thorough
clinical examination and evaluation of available
physiologic variables (heart rate, blood pressure,
arterial oxygen saturation, respiratory rate,
temperature, urine output, and others, as available)
as well as other noninvasive or invasive monitoring,
as available.
6. Initial Resuscitation
An initial target MAP of 65 mmHg in
patients with septic shock requiring
vasopressors (strong recommendation,
moderate quality of evidence).
Guiding resuscitation to normalize lactate
in patients with elevated lactate levels as a
marker of tissue hypoperfusion (weak
recommendation, low quality of evidence).
7. Application of Fluid Resuscitation in Adult Septic Shock
Considerations post 30ml/kg crystalloid infusion
1. Continue to balance fluid resuscitaon and vasopressor dose with attention to maintain tissue perfusion and minimize interstitial edema
2. Implement some combinaon of the list below to aid in further resuscitaon choices that may include addional fluid or inotrope therapy
• blood pressure/heart rate response,
• urine output,
• cardiothoracic ultrasound,
• CVP, ScvO2,
• pulse pressure variaon
• lactate clearance/normalizaon or
• dynamic measurement such as response of flow to fluid bolus or passive leg raising
3. Consider albumin fluid resuscitaon, when large volumes of crystalloid are required to maintain intravascular volume.
Sepsis-induced hypotension or lactate > 4 mmol/L
(Based on SSC bundle and CMS threshold)
No high flow oxygen and
No ESRD on dialysis or CHF
Pneumonia or ALI with high
flow oxygen requirements
ESRD on hemodialysis
or CHF
Rapid infusion
of 30 ml/kg
Crystalloid*
Not intubated/
mechanically ventilated
Intubated/
mechanically ventilated Total of 30 ml/kg crystalloid*
with frequent reassessment
of oxygenation
If no
If
Yes
Consider
intubaon/mechanical
venlaon to facilitate
30 ml/kg crystalloid *
Rapid infusion
of 30 ml/kg
crystalloid *
Total of 30 ml/kg with
frequent reassessment of
oxygenaon
9. Diagnosis
Appropriate routine microbiologic cultures
(including blood) be obtained before
starting antimicrobial therapy in patients
with suspected sepsis or septic shock if
doing so results in no substantial delay in
the start of antimicrobials (BPS).
Remarks Appropriate routine microbiologic
cultures always include at least two sets of blood
cultures (aerobic and anaerobic).
11. Antimicrobial Therapy
Administration of IV anti-microbials be
initiated as soon as possible after
recognition and within 1 h for both sepsis
and septic shock (strong recommendation,
moderate quality of evidence; grade
applies to both conditions).
12. Antimicrobial Therapy
Empiric broad-spectrum therapy with one or
more antimicrobials for patients presenting
with sepsis or septic shock to cover all likely
pathogens (including bacterial and potentially
fungal or viral coverage) (strong
recommendation, moderate quality of
evidence).
Empiric antimicrobial therapy be narrowed once
pathogen identification and sensitivities are
established and/or adequate clinical
improvement is noted (BPS).
13. Antimicrobial Therapy
Antimicrobial treatment duration of 7–10
days is adequate for most serious
infections associated with sepsis and
septic shock (weak recommendation, low
quality of evidence).
14. Antimicrobial Therapy
Measurement of procalcitonin levels can be
used to support shortening the duration of
antimicrobial therapy in sepsis patients (weak
recommendation, low quality of evidence).
Procalcitonin levels can be used to support
the discontinuation of empiric antibiotics in
patients who initially appeared to have sepsis,
but subsequently have limited clinical
evidence of infection (weak recommendation,
low quality of evidence).
16. Source Control
A specific anatomic diagnosis of infection
requiring emergent source control be
identified or excluded as rapidly as
possible in patients with sepsis or septic
shock, and that any required source
control intervention be implemented as
soon as medically and logistically practical
after the diagnosis is made (BPS).
17. Source Control
Prompt removal of intravascular access
devices that are a possible source of
sepsis or septic shock after other vascular
access has been established (BPS).
18.
19. Fluid Therapy
Crystalloids as the fluid of choice for initial
resuscitation and subsequent intravascular
volume replacement in patients with sepsis
and septic shock (strong recommendation,
moderate quality of evidence).
Against using hydroxyethyl starches (HESs)
for intravascular volume replacement in
patients with sepsis or septic shock (strong
recommendation, high quality of evidence).
20. Fluid Therapy
Using albumin in addition to crystalloids for
initial resuscitation and subsequent
intravascular volume replacement in
patients with sepsis and septic shock
when patients require substantial amounts
of crystalloids (weak recommendation, low
quality of evidence).
21.
22. Vasopressors
Norepinephrine as the first choice
vasopressor (strong recommendation,
moderate quality of evidence).
Adding either vasopressin (up to 0.03 U/min)
(weak recommendation, moderate quality of
evidence) or epinephrine (weak
recommendation, low quality of evidence) to
norepinephrine with the intent of raising MAP
to target, or adding vasopressin (up to 0.03
U/min) (weak recommendation, moderate
quality of evidence) to decrease
norepinephrine dosage.
23. Vasopressors
Using dopamine as an alternative
vasopressor agent to norepinephrine only
in highly selected patients (e.g., patients
with low risk of tachyarrhythmias and
absolute or relative bradycardia) (weak
recommendation, low quality of evidence).
Against using low-dose dopamine for renal
protection (strong recommendation, high
quality of evidence).
24. Vasopressors
Using dobutamine in patients who show
evidence of persistent hypoperfusion
despite adequate fluid loading and the use
of vasopressor agents (weak
recommendation, low quality of evidence).
25. Vasopressors
All patients requiring vasopressors have an
arterial catheter placed as soon as
practical if resources are available (weak
recommendation, very low quality of
evidence).
26. Vasopressor Use for Adult Sepc Shock
(with guidance for steroid administraon)
Iniate norepinephrine (NE) and trate up to 35-90 μg/min
to achieve MAP target 65 mm Hg
MAP target
achieved
Connue norepinephrine alone or
add vasopressin 0.03 units/min
with ancipaon of decreasing
norepinephrine dose
MAP target not achieved
and judged
poorly responsive to NE
Add vasopressin up to
0.03 units/min to achieve
MAP target*
MAP target
achieved
MAP target
not achieved
Add epinephrine up to
20-50 μg/min to achieve MAP
target**
MAP target
achieved
MAP target
not achieved
Add phenylephrine up to
200-300 μg/min to
achieve MAP target***
* Consider IV steroid administraon
** Administer IV steroids
*** SSC guidelines are silent on phenylephrine
Notes:
• Consider dopamine as niche vasopressor in the presence
of sinus bradycardia.
• Consider phenylephrine when serious tachyarrhythmias
occur with norepinephrine or epinephrine.
• Evidence based medicine does not allow the firm
establishment of upper dose ranges of norepinephrine,
epinephrine and phenylephrine and the dose ranges
expressed in this figure are based on the authors
interpretaon of the literature that does exist and personal
preference/experience. Maximum doses in any individual
paent should be considered based on physiologic response
and side effects.
28. Corticosteroids
Against using IV hydrocortisone to treat
septic shock patients if adequate fluid
resuscitation and vasopressor therapy are
able to restore hemodynamic stability. If
this is not achievable, we suggest IV
hydrocortisone at a dose of 200 mg per
day (weak recommendation, low quality of
evidence).
30. Blood Product Administration
RBC transfusion occur only when
hemoglobin concentration decreases to
<7.0 g/dL in adults in the absence of
extenuating circumstances, such as
myocardial ischemia, severe hypoxemia,
or acute hemorrhage (strong
recommendation, high quality of evidence).
31. Blood Product Administration
Prophylactic platelet transfusion
when counts are <10,000/mm3 in the
absence of apparent bleeding and
when counts are <20,000/mm3 if the
patient has a significant risk of bleeding.
Higher platelet counts (≥50,000/mm3) are
advised for active bleeding, surgery, or
invasive procedures (weak
recommendation, very low quality of
evidence).
33. Glucose Control
A protocolized approach to blood glucose
management in ICU patients with severe
sepsis commencing insulin dosing when 2
consecutive blood glucose levels are >180
mg/dL. This protocolized approach should
target an upper blood glucose ≤180
mg/dL rather than an upper target blood
glucose ≤ 110 mg/dL (strong
recommendation, high quality of evidence).
34. Glucose Control
Blood glucose values be monitored every
1–2 hrs until glucose values and insulin
infusion rates are stable and then every
4 hrs thereafter in patients receiving
insulin infusions (BPS).
36. Bicarbonate Therapy
Against the use of sodium bicarbonate
therapy to improve hemodynamics or to
reduce vasopressor requirements in
patients with hypoperfusion-induced lactic
acidemia with pH ≥ 7.15 (weak
recommendation, moderate quality of
evidence).
37. 西暦 2017年1月17日
輸液
☐ Crystalloids ± albumin
☒ HESs
昇圧剤
☑ Norepinephrine ± vasopressin or epinephrine
☐ Dopamine for bradycardia only
類固醇
☐ Hydrocortisone 200 mg/day for refractory shock
輸血
☑ pRBC: Hb < 7
☐ platelet: 10K, 20K, 50K
血糖制御 < 180 mg/dl
重炭酸塩 pH < 7.15
Intensive Care Medicine
doi: 10.1007/s00134-017-4683-6
症、襲来
敗
血
症 SSC Guidelines 2016
蘇生補完計画
☑ Crystalloid ≥ 30 ml/kg within 3 hrs
☐ Target MAP ≥ 65 mmHg
☐ Normalize lactate
☒ EGDT, CVP, ScvO2
抗生物質
☑ Empiric broad-spectrum ABx within
1 hr
☐ Procalcitonin to support the
discontinuation of ABx
感染源制御
☐ as soon as possible