Sepsis Multicast Episode 6.0: Sepsis Smackdown with Chad Case, MD

We brought in Chad Case, MD: our System ICU Director and Chief of Critical Care at our hospital system to talk controversies in sepsis management. Is EGDT dead? If so, what do we teach non-intensivists that staff 70% of ICUs nation-wide? Does dobutamine belong in the trash along with CVP, ScvO2, passive leg raise, PA caths & POCUS? Is there anything we CAN do nowadays??

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Jeremy AmayoComment
Should They Stay or Should They Go? ECMO, ARDS and When to Transfer Downtown

We work in a multi-hospital system made up of multiple secondary community hospitals and one large quarternary facility downtown. Our community hospitals have a strong ICU team who routinely admit and manage patients with severe ARDS. They are capable of paralytics and proning but do not have access to ECMO. The questions we often struggle with are: who needs to transfer for ECMO? when do they need to transfer? how do we know who will end up being too sick to transfer? at what point should we make the phone call to the big house?

We sat down with our ICU director and our local ECMO guru to answer these questions. Tune in!

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Atrial Fibrillation

Definitions

  • Paroxysmal - terminates spontaneously, without intervention in 7d (or has in past)
  • Persistent - > 7 days
  • Long-standing persistent - > 12 mo
  • Permanent - cardioversion failed or never attempted 
  • Valvular - 2/2 rheumatic mitral stenosis, mechanical valve or mitral valve repair
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