LEARNING OBJECTIVES:

KNOWLEDGE: Students should be able to describe:

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SKILLS: Students should be able to:

HISTORY AND PHYSICAL EXAM:

COMMUNICATION SKILLS:

MANAGEMENT:

 

 

 

 

 

 

ATTITUDES AND PROFESSIONAL BEHAVIORS: Students should be able to:

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REFERENCES:

Hemodynamics

  1. Connors AF et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA 1996;276:889-897. This famous prospective cohort study found worse outcome with use of PACs in the critically ill, instantly becoming a source of enormous controversy. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8782638
  2. Richard C, Warszawski J, Anguel N, et al. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. JAMA 2003;290:2713-20. This multicenter study of 676 patients with common indications for PA catheter placement in the MICU found neither harm nor benefit with catheter placement.  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14645314&query_hl=1&itool=pubmed_docsum   

Specific Strategies for Resuscitating Patients in Shock EGDT or Not

  1. Rivers E, et al. Early Goal Directed Therapy in the Treatment of Severe Sepsis and Septic Shock. NEJM 2001;345(19):1368-77.
  2. The ProCESS Trial: NEJM 2014 (1); 1683-93.

Steroids for Severe Sepsis

  1. Annane D, et al. The Effect of Treatment with Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients with Septic Shock. JAMA 2002;288(7):862-71.
  2. Keh D, et al. Immunologic and Hemodynamic Effects of “Low-Dose” Hydrocortisone in Septic Shock. AJRCCM 2003;167:512-520.

Vasopressin for Severe Sepsis

  1. Landry DW and Oliver JA. Mechanisms of Disease: The Pathogenesis of Vasodilatory Shock [Review Article].NEJM 2001(8);345:588-95
  2. Landry et al. Circulation 1997;95:1122.

Saline is as good as albumin

  1. NEJM 2004:350;2247-56.
  2. NEJM 2014: 370(15); 1412-21.

Lactic Clearance:

  1. JAMA 2010

 

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