Practical Evidence Podcast 015 – Surviving Sepsis Campaign (SSC) Guidelines 2016 (in 2017)
Summary: <a href="http://emcrit.org/wp-content/uploads/2017/01/Screen-Shot-2017-01-19-at-3.18.27-PM.png"></a>Image Taken from the FOAMCast Episode<br> <br> We've discussed SEPSIS a ton on EMCrit.<br> <br> * <a class="yoast-link-suggestion__value" href="http://emcrit.org/podcasts/sepsis-panel-smaccback/" target="_blank">Podcast 154 - Preemptive Sepsis Panel SmaccBack</a><br> * <a class="yoast-link-suggestion__value" href="http://emcrit.org/wee/wee-cliff-deutschman-additional-thoughts-sepsis-3-0/" target="_blank">Wee - Cliff Deutschman with Additional Thoughts on Sepsis 3.0</a><br> * <a class="yoast-link-suggestion__value" href="http://emcrit.org/pulmcrit/renoresuscitation-sepsis-resuscitation-designed-to-avoid-long-term-complications/" target="_blank">Renoresuscitation: Sepsis resuscitation designed to avoid long-term complications</a><br> * <a class="yoast-link-suggestion__value" href="http://emcrit.org/podcasts/fluids-severe-sepsis/" target="_blank">Podcast 112 - A Response to the Marik Sepsis Fluids Lecture</a><br> * <a class="yoast-link-suggestion__value" href="http://emcrit.org/podcasts/sepsis-3/" target="_blank">Podcast 169 - Sepsis 3.0 with Merv Singer</a><br> * <a class="yoast-link-suggestion__value" href="http://emcrit.org/podcasts/lessons-sepsis-collaborative/" target="_blank">Podcast 89 - Lessons from the STOP Sepsis Collaborative</a><br> <br> 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, <a href="http://twitter.com/jeremyfaust">Jeremy Faust</a>, to discuss the changes. Jeremy is 1/2 of the FOAMcast podcast which just discussed the new guidelines in a <a href="http://foamcast.org/2017/01/19/suviving-sepsis-campaign-guidelines-2017/">recent episode</a>.<br> Guideline Stuff<br> <br> * <a href="http://journals.lww.com/ccmjournal/Abstract/publishahead/Surviving_Sepsis_Campaign___International.96723.aspx">The SSC 2016 Guidelines</a><br> * <a href="http://emcrit.org/wp-content/uploads/2017/01/Surviving_Sepsis_Campaign___International.96723.pdf">PDF Version of the SSC 2016</a><br> * <a href="http://emcrit.org/wp-content/uploads/2017/01/A_Users__Guide_to_the_2016_Surviving_Sepsis.96722.pdf">Users' Guide to the Guidelines</a><br> * <a href="http://emcrit.org/wp-content/uploads/2017/01/1-s2.0-S0733862716300761.pdf">Our Emergency Medicine Clinics Article</a><br> <br> The Guideline Recommendations<br> The Definition of Sepsis<br> <a href="http://emcrit.org/wp-content/uploads/2017/01/explaining-SIRS-and-Sepsis.gif"></a><br> <br> They basically ratified SEPSIS 3.0<br> <br> (Jeremy found where he saw the remnants of the old definition; it was in the Users' guide figure 2--super contradictory)<br> Fluids<br> 30 ml/kg in the first 3 hours<br> <br> Crystalloid first, then maybe albumin<br> <br> Use dynamic markers and/or fluid challenges<br> <br> Goal MAP>65<br> <br> EGDT is no longer recommended<br> Lactate<br> attempt to normalize lactate<br> Blood Cultures<br> get them before antibiotics, if obtaining them will not delay the provision of antibiotics<br> Antibiotics<br> Within 1 hour of sepsis or septic shock<br> Vasopressors<br> Norepi is the first choice, add in epi or vaso<br> <br> Do not use dopamine<br> Steroids<br> 200 mg Hydrocortisone for patients who are still unstable after fluids and vasopressors<br> Blood<br> In most circumstances, use a trigger of <7.0 g/dL<br> Glucose<br> goal is < 180 mg/dL<br> Bicarb<br> Not recommended if pH is >7.
