Antibiotics in Sepsis: Is Early Always Better?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – antibiotic stewardship, antibiotics, antimicrobial stewardship, Arterial Line, Arterial line insertion, Arterial line placement, Arterial Lines, Central Line, Central line insertion, central line placement, central lines, Central Venous Catheter, central venous catheters, Featured, Sepsis, Septic Shock, severe sepsis, shock, Systemic inflammatory response syndrome
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Timely administration of broad-spectrum antibiotics in septic patients saves lives.  Though this has been demonstrated in hundreds of clinical investigations over the last few decades, antibiotics remain the most controversial topic in the management of severe sepsis and septic shock. …
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Maneuvers to Assess Fluid Responsiveness in Septic Shock or Vasodilatory Shock

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial Line, Arterial line insertion, Arterial line placement, Arterial Lines, Featured, HPC Updates, Sepsis, Septic Shock, severe sepsis, shock
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Aggressive fluid administration is a hallmark of septic shock management and has been espoused by the Surviving Sepsis Campaign and is a part of the CMS SEP-1 sepsis bundle. The sepsis bundle includes administration of 30 ml/kg crystalloid bolus (LR…
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Dexmedetomidine and Propofol performed equally well for the sedation of mechanically ventilated patients with sepsis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – BLOG OF THE WEEK, Delirium, Featured, Fentanyl-Based Ventilator, HPC Updates, Mechanical Ventilation, RASS, Richmond Agitation-Sedation Scale, Sedation, Sepsis, Septic Shock, severe sepsis, Ventilation, Wake-up and Breath Protocol
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The Society of Critical Care Medicine (SCCM) recommends that all mechanically ventilated patients receive analgesia, sedation, and delirium assessment and management while intubated. SCCM reinforced these principles in their 2018 clinical practice guideline on the prevention and management of pain,…
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Continuous Infusion of Beta-Lactam Antibiotics is Superior to Intermittent Dosing for Sepsis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – antibiotics, beta-lactam antibiotics, HPC Updates, Sepsis, Septic Shock
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The bactericidal activity of antibiotics depends on the class of antibiotic used. Some antibiotics like vancomycin, aminoglycosides and fluoroquinolones are dose-dependent for their bactericidal activity. Other antibiotics like beta-lactam antibiotics are time-dependent antibiotics.  Time-dependent antibiotics have increased bactericidal activity the…
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Summary of Sepsis and Septic Shock Treatment in 2017

Joseph Esherick, M.D., FAAFP, FHM
More Articles – ARDS, Arterial Lines, central lines, hemodynamic monitoring, HPC Updates, Mechanical Ventilation, Sepsis, Septic Shock, vasopressors
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Definitions Presumed source with SIRS criteria = infection Infection with life-threatening organ dysfunction = sepsis Sepsis refractory to intravenous fluid challenge = septic shock Treatment of sepsis or septic shock Draw blood cultures x 2 Analyze any fluid that may…
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Continuous-Infusion Beta-Lactam Antibiotics is Superior to Intermittent Dosing in Septic Patients?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – beta-lactam antibiotics, critical illness, HPC Updates, Sepsis, Septic Shock, severe sepsis
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The bactericidal activity of antibiotics depends on the class of antibiotic used. Some antibiotics like vancomycin, aminoglycosides and fluoroquinolones are dose-dependent for their bactericidal activity. Other antibiotics like beta-lactam antibiotics are time-dependent antibiotics which depend on maintaining drug concentrations above…
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Early Goal Directed Therapy for Sepsis: No Longer?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Central Line, central line placement, Central Venous Catheter, HPC Updates, Procedure Blog of the Week, Sepsis, Septic Shock
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In 2001, the Rivers trial showed that Early Goal Directed Therapy for septic shock resulted in a 16% absolute mortality risk reduction1. In the treatment arm of this trial, septic patients with a lactate above 4 mmol/L or systolic blood…
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