Some of the biggest challenges facing emergency physicians can be managing the sickest of the sick. Peter M.C. DeBlieux, MD, FACEP, director of emergency medicine services at the Medical Center of Louisiana at New Orleans, Louisiana State University Health Science Center Interim Hospital, shared some of the latest trends in critical care management. The suggestions came fast and furiously.
Dr. DeBlieux noted that identifying systemic inflammatory response syndrome (SIRS) and sepsis can present a challenge in the ED. The problem is that these patients often are sicker than they appear, he noted. One strategy he finds helpful is the Shock Index. “I’m using it more and more,” he said. Another indicator that a patient is really sick is if the heart rate is higher than the systolic blood pressure.
He used a memory technique that helps the process, focusing on the patient’s tank (volume status), hose (systemic vascular resistance), and pump (cardiac assessment). To correctly identify volume status, Dr. DeBlieux recommends using inferior vena cava ultrasound. He also suggested treating with balanced solutions to increase volume rather than only considering normal saline.