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THE UNIT: The Official Newsletter of the ACEP Critical Care Medicine Section - Summer 2017

Metabolic Resuscitation for Sepsis, A Career in Academic EM/CCM, Peripheral Vasopressors, Ultrasound Training in CCM

A Critical Appraisal of Metabolic Resuscitation for Sepsis

Over the last 20 years, the focus on early antibiotic administration and fluid resuscitation in sepsis care has brought the mortality rate for cases of severe sepsis and septic shock from 30-40%1, 2 to approximately 20-25%.3, 4 However in the past several years, it seems that we have reached a plateau in improving the treatment of sepsis. But in March of 2017, Dr. Paul Marik of Eastern Virginia Medical School, one of the most distinguished intensivists in the United States, published a study that he believes may drastically turn the tide on the battle against this deadly disease. Read more now.

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Peripherally versus Centrally Administered Potent Vasopressors in the ICU

Vasopressors are commonly used medications in the emergency department (ED) and intensive care unit (ICU). Because of a perceived morbidity and risk of peripherally delivered vasopressors, the standard practice (and indeed, often hospital protocols) mandates administration of these drugs through a central venous catheter (CVC), rather than a peripheral intravenous catheter (PIV). However, studies have shown a significant increase in mortality with every hour delay of vasopressor initiation in hypotensive patients.1 Given this risk, vasopressors are often times initiated through a PIV until a CVC can be placed. But what about continuing a vasopressor peripherally in an effort to avoid a CVC all together? Read more now.

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We have learned a bunch about the management of the critically ill patient in the ED from the practice of critical care. What can emergency medicine teach the specialty of critical care? Can we dare use the epithet ‘downstairs care upstairs’? Read more now.

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Landing in the Martini

Strickler MDA pencil drawing in my office crudely depicts an airplane flying with an anticipated trajectory of a martini with two olives. Over five years ago, my dear friend from residency drew this for me. He said, “Now, the goal of each shift is to be the pilot of this full flight. Carefully navigate it through all of the turbulence and smoothly land the plane into the martini without crashing.” With my first year of practice as an attending in an academic center nearly complete, I cannot help but reflect on my piloting skills during this past year. Read more now.

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Ultrasound Training in CCM Programs

Everyone acknowledges that ultrasound training in critical care programs is important. But exactly how one does this is challenging to conceptualize. We are not talking about just occasionally using ultrasound or learning a little during rounds aka “informal teaching”, but developing educational pathways that allow critical care medicine providers to become as comfortable utilizing point of care ultrasound (POCUS) as they are with the ventilator or vasopressors. No one is arguing the importance of POCUS, rather what is the best way to educate and train fellows in critical care ultrasound (CCUS). Read more now..

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Section Officer Elections

The ACEP Critical Care Medicine Section will elect officers prior to the annual meeting to be held on October 30th during ACEP17 in Washington, DC. Election results will be announced at the meeting. Read more now.

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