This is an excerpt from a Zoom-based Grand Rounds I presented to my friends in India in November 2023

Concepts:
1. Is it Sepsis?
Think broadly about other causes of hypotension or lactatemia

2. Primary Survey and Resuscitation
ABCs, antibiotics

3. Thorough Source Identification
History, examination, Sepsis Secondary Survey, Ultrasound, Labs & Micro specimens, Radiology including low threshold for CT

Don't stop looking if you find a positive urinalysis in an asymptomatic elderly patient! Also remember lower zone CXR abnormalities can sometimes be secondary to abdominal mischief!

4. Thorough Source Control
We're good at DRUGS (antibiotics) but delays to surgical source control can kill so consider DRAINAGE and DEBRIDEMENT. Remember also that medical DEVICES can get infected


Idea for 4 D's is adapted from Marshall JC, Al Naqbi A. Principles of source control in the management of sepsis. Crit Care Nurs Clin North Am. 2011 Mar;23(1):99-114

Sepsis Secondary Survey comes from Sara Crager - check out her wonderful work at https://www.icuedu.org/

Surgical paper cited: Reitz KM, Kennedy J, Li SR, et al. Association Between Time to Source Control in Sepsis and 90-Day Mortality. JAMA Surg. 2022;157(9):817–826
https://jamanetwork.com/journals/jama...