Fluids and Early Vasopressors in the Management of Septic Shock: Do We Have the Right Answers Yet? Conclusions "Based on current evidence, the very early use of norepinephrine and its combination with smaller amounts of IV fluids in fluid-responsive hypotensive septic shock

As a senior resident, I thought I had a pretty strong understanding of sepsis and septic shock. But after doing a deep dive, I realized there's so much nuance. Here's my approach to workup and management, along with some key pearls and lessons. - Thread - 1/26

A practical Point of Care Medicine guide to working up and managing sepsis and septic shock, loaded with high-yield clinical pearls.

In sepsis, lactate is bad and needs to be corrected immediately via aggressive fluid resuscitation, right? Well, maybe. But it's complicated. A brief thread on lactate in sepsis! 1/7

Some key pearls on fluid resuscitation in sepsis: - Focus on euvolemia, MAP, and cap refill - A good deal of fluid will leak out of vessels - more than 2-3L (30cc/kg) of LR is rarely helpful - Low UOP or AKI may not be prerenal but rather ATN and will not improve with fluid

TUH #sepsis #simwars is back! Wednesday 13th September 10 am-2.30 pm in the atrium. Come & support our 5 consultant led multidisciplinary teams compete in a live #simulation to raise awareness of sepsis. Who will be TUH Sepsis Sim Wars champion 2023?#thinksepsisactfastsavelives

Well done Aidan Grufferty & the EM team! Excellent technical & non technical skills performance at the TUH #sepsis Sim War competition 2023 for World Sepsis Day MDT #simulation based education to raise awareness of #sepsis #TeamTUH 👏👏👏 #thinksepsisactfastsavelives

Congratulations to all the teams today. There were some brilliant technical and non-technical skills on display. Thank you to everyone who gave their time to make it such a successful day TUH ED Victoria Meighan Deepthi Chakkittakandy Pat Conroy

Congratulations to Aidan Grufferty and his team from Emergency Medicine who won this year's TUH #sepsis Sim Wars! Sim Wars is a TUH simulation competition to see which team of medics is best at identifying and treating sepsis. Well done to all those who took part! #stopsepsis

Don't Let Your Patient Bleed To Death! A Structured Approach to Managing A Patient With Life Threatening Bleeding Using A Quick Reference Guide to Remind Your Team Of The Key Steps This is Part One and covers GENERAL MEASURES Video 6 min 52 secs youtu.be/v7TibTiDXoQ?si…

Stopping someone from bleeding to death requires many keys steps Our team uses this cognitive aid Page 1 covers general measures to guide vascular access, haemostatic resuscitation, reversal of anticoagulation, and optimising of clotting 1/10

" THORACIC WALL BLOCKS: An Art of Looking Between the Lines" #Thoracicwallblocks #Chestwallblocks #Parasternalblocks #PECSblocks #SAPblocks #PVB #ESPblock #RISSblock #ITPblock My 10 points between 6 LINES: ANTERIOR CHEST WALL BLOCKS: (A) Medial to the Midclavicular line:

Great day organising the consultant Christmas sim. Role model simulation which consolidated our excellent training days this year. We had a pregnant PE cardiac arrest and resustative hysterotomy. TUH ED Cathy Mullen Sandra Hartigan @ICUTallaght University Hospital National Ambulance Service 🇮🇪🚑 Victoria Meighan

Christmas SIM in TUH ED with consultants being tested after Mrs Claus has a medical emergency 🚨🤶 Lucky the ED team, @ICUTallaght University Hospital are on hand Teamwork, leadership, definitive medical care and fun on display Allocated roles, checklists, read back, communication all essential

ED crowding in one slide. Patients come to harm and die, Staff come to harm. The system suffers too. It’s really bad. Ian Higginson 🌈 #RCEMcpd

Super #teamwork, leadership & communication in our NAS/EM/ICU interdisciplinary in situ #simulation training today! Recognising & managing #sepsis, necrotising fasciitis & septic shock. Medication safety review of safe prescribing; opiates, antibiotics & inotropes. Go Team TUH!🙌

#shouldertoshoulder IRFU Safe Rugby Aidan Grufferty

ICU Hemodynamics: There is a lot of discussion about the role of methylene blue (MB) in refractory #septicshock. We don't have many RCTs in this topic & I read every new one with interest. This small RCT was recently published:

Come join the Team in Tallaght! ⁦TUH ED⁩ ie.indeed.com/viewjob?jk=0e9…

To quote the late great Dr John Hinds.... Either you do the thoracotomy or the pathologist will