Comparison: Other various sedative agents.Intervention: Single dose etomidate for RSI.Population: Septic patients requiring mechanical ventilation (pediatrics excluded).Reference: Chan CM et al, Etomidate is associated with mortality and adrenal insufficiency in sepsis: a meta-analysis. *Targets for quantitative resuscitation included in the guidelines are CVP of ≥8 mm Hg ScvO2 of ≥70%, and normalization of lactate. –Measure central venous oxygen saturation (ScvO2)*ħ) Remeasure lactate if initial lactate was elevated* Central Venous Pressure Monitoring (Grade D)ĪCEP Surviving Sepsis Campaign Bundles 2012:Ģ) Obtain blood cultures prior to administration of antibioticsĤ) Administer 30 ml/kg crystalloid for hypotension or lactate ≥4mmol/Lĥ) Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a mean arterial pressure (MAP) ≥65 mm HgĦ) In the event of persistent arterial hypotension despite volume resuscitation (septic shock) or initial lactate ≥4 mmol/L (36 mg/dL):.Key Aspects Early Recognition ( Grade of Recommendation): Morbidity and mortality increase if a patient deteriorates from sepsis to severe sepsis to multiorgan dysfunction (CAEP)”. Sepsis is a syndrome, and can range from relatively mild (simple infection) to severe (septic shock and multiorgan dysfunction). Both ACEP and CAEP have guidelines that address optimal management of severe sepsis.ĭefinition of sepsis: “Sepsis is defined as the presence of both systemic inflammatory response syndrome and the suspicion of an infection. This includes the Surviving Sepsis Campaign and the Early Goal-Directed Therapy. Question: Can you use Etomidate for RSI in septic patients?īackground: Sepsis has received more attention over the last 5 years or so. He is difficult to rouse and you decide he needs rapid sequence intubation. His vital signs are blood pressure 76/48mmHg, heart rate 110bpm, oxygen sat 86% and temperature of 39.5C. He has a history of hypertension, benign prostatic hypertrophy, dyslipidemia and osteoarthritis. No specific complaints of chest pain, shortness of breath, abdominal pain or focal weakness. Sunned is also the Chair of the CAEP Guideline Committee.Ĭase Scenario: 70 year old man arrives by ambulance from home with complaining of being weak and dizzy. He is an Associate Clinical Professor of Emergency Medicine and Associate Member in the Department CEB at McMaster University.
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