Lars-Kristofer Peterson, MD
Remember to look at the differential of your CBCs. A recent publication demonstrated in retrospective data that higher proportions of bands on the WBC differential were associated with increased likelihoods of both severe bloodstream infections and mortality.
Great teams review their performances. A recent publication from George Washington University used video of cardiac arrest resuscitations to generate educational interventions to minimize pulse checks during resuscitation.
It’s a familiar call ahead to the ED - an adult patient who is febrile, hypotensive, with suspicion towards infection. While setting up the room, the patient’s bedside nursing team asks if you’d like them to get saline or lactated Ringer’s (LR) ready for resuscitation. You wonder if there’s any new evidence examining the use of saline versus balanced crystalloids in the emergency department.
It's a typical day in the ED. You are asked to see your next patient who is a 60 year old male, recently discharged from the hospital after being treated for cellulitis presenting with abdominal pain and diarrhea. He’s tachycardic and hypotensive to 75/40. The patient is mentating well. After taking a more thorough history your differential diagnosis narrows in on intra-abdominal sepsis associated with significant volume losses. The lactate returns at 6. On volume assessment by physical exam and POCUS, the patient is significantly volume down. You know that getting the antibiotics and fluids on board is the cornerstone of treatment, but they will take some time to be given. You wonder if you should temporize your resuscitation with pressors during the time it takes for the fluids and antibiotics to be administered.