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EMGuidewire's Podcast

Sep 23, 2019

Join the EMGuideWire Crew as they continue to explore the High Yield management points for Sepsis! 

This week's Episode's Pearls:

  • Early fluids save lives. Give 40cc/kg bolus in first 3 hours. But don’t fluid overload the patient!

  • U/S the heart and lungs: A plethoric IVC, immobile mitral valve, and B lines on the lungs should urge you to be more cautious with fluids.

  • Goal in all patients is to establish an adequate MAP ASAP! Fluids + Vasopressors!

  • Vasopressor titration algorithm: First low dose NE (10mcg/min); if still in shock, initiate vasopressin (0.04 units/min); do not wait on providing vasopressin if EPI is readily available (establish MAP ASAP!). 

  • Initiate vasopressors early with fluids! NE can be initiated peripherally, so don’t wait for a central line!

  • Only consider dopamine for absolute bradycardia. 

  • Methylene blue is a last resort consideration. 

  • Vasopressors are commonly needed at high doses (i.e., 1mcg/kg/min EPI). 

  • Hydrocortisone 50-100mg for patients with septic SHOCK, not sepsis alone. 

Summarized by: Travis Barlock, MD PGY-1


  • Farkas J. PulmCrit- Epinephrine challenge in sepsis: An empiric approach to catecholamines. EMCrit Project. Published August 21, 2018. Accessed September 17, 2019.

  • Dellinger RP, Levy MM, Rhodes A, et al. 2017. Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup: Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2016. Critical Care Medicine. 44(3):486-552.