Tamingthesru
Grand Rounds Recap: Critical Care Symposium - 2/4/15
Pressor Primer with Dr. Hebbeler-Clark
- Norepinephrine seems to be on top in terms of vasopressor of choice currently (consider it your "easy button")
- Per Surviving Sepsis Guidelines, Norepi has level 1B evidence as a first line pressor, while Epi is your second line with level 2B evidence and Vasopressin is currently ungraded in terms of evidence level
- There have been 4 RCT's confirming that Norepi has no mortality difference from Epi and given it's safer side effect profile, use it regularly
Grand Rounds Recap - 1/28/15
Mortality & Morbidity Conference with Dr. Bohanske
When volumes are high, remember the patient experience can be improved by acknowledging wait times when entering the room and apologizing for their wait.
Transverse myelitis is a result of partial inflammation of the spinal cord that can sometimes lead to necrosis.
- The disease process is often progressive and function does not always return after treatment.
- Most commonly this is idiopathic in nature but it is often attributed to a post-infectious inflammatory state.
- Differential diagnosis should always include cord ischemia versus compression, and diagnosis hinges on a T2-weighted MRI.
The Search for the Holy Grail: Assessment of Fluid Responsiveness
Last week our residents and faculty met for journal club in search of the holy grail.. err.. I mean, to talk about ways to assess volume responsiveness. A couple of weeks back the PGY-1 and 2 residents met and discussed a number of questions they had about the care and management of patients with sepsis. The discussion hit on a number of key topics: empiric antibiotic selection, timing of antibiotics, choice of vasopressors, etc. Ultimately the group decided they wanted to take a closer look at non-invasive ways to assess volume responsiveness and guide resuscitation in septic patients.