Sepsis 3.0

This episode is a total revamp of the previous episode on sepsis.  If you go back to the original post on Sepsis, you’ll also find it replaced as well with this new episode.

A lot has changed with sepsis management since I published the sepsis episode in February 2012 so it was time for a complete overhaul.  The new sepsis guidelines have been out for about a year and I finally got around to updating the episode.  The new Surviving Sepsis Guidelines also just came out in a few months ago and those recommendations are included as well.  This episode will discuss the recognition of sepsis, how to do a good physical exam and ask the right history questions, order the right tests, and aggressively resuscitate these very sick patients.

There is also a separate episode that discusses the old sepsis definitions and how you can use that framework to recognize sepsis.

Sepsis 3.0 podcast

Old Sepsis definitions podcast (mini-episode)

Sepsis 3.0 March 2017 Show Notes (Word Format)

Sepsis 3.0 Updated March 2017 Show Notes (PDF)


Links mentioned during the show:


The original Rivers Trial

Rivers Early Goal Directed Therapy for Sepsis Original Study (Free access)

EM Basic Essential Evidence Episode on the Rivers Trial


Primary Literature- Free Open Access

New Sepsis Definitions (2016)

New Surviving Sepsis Campaign Guidelines (Published January 2017)


Blogs/podcasts discussing the new Sepsis Guidelines

EmCrit on New Sepsis Definitions (2016)

FOAMcast on the New Sepsis Definitions (2016)

FOAMcast on the New Surviving Sepsis Guidelines (2017)

Practical Evidence (EmCrit with Jeremy Faust) on the New Surviving Sepsis Guidelines (2017)

PulmCrit/EmCrit on the Surviving Sepsis “Myths” (2017)


Ashley Shreeves on Palliative Care in the ED (amazing talks- a must listen)

-Emcrit (Talking with families)

-Emcrit (Nuts and bolts of Critical Care Palliation)

-SMACC Chicago

-SMACC Dublin


ARISE, PROMISE, and PROCESS Trial Analyses

Emcrit on ARISE

The Bottom Line on PROMISE



Fluid Tolerance

EmCrit on Fluid Tolerance/Fluid Responsiveness

The Ultrasound Podcast with lots of episodes on Fluid Responsiveness


Peripheral Pressor Safety and Extravasation

EmCrit on Vasopressor Extravasation

PulmCrit on Safety of Peripheral Pressors


Intubation in Sepsis- low dose sedatives, high dose paralytics

EmCrit on Intubating Shocked Patients


Note: If there are any other good resources out there that you think should be included, email me at and I’ll include them.


Don’t forget about our bandwidth sponsor, EB Medicine.  Check out there numerous resources on ED sepsis care and critical care as well.  Residents can get free access and attendings can get a discount at the EM Basic EB Medicine page.

Croup by Stewart Harsant and Taylor Fischer, PA-Cs

Today’s episode is on Croup- just in time for the middle of the croup season.  Your ED may even be filled with kids with a barking cough as we speak.  Today’s episode was written by Taylor Fischer and Stewart Harsant, two physician assistants who have done an excellent job of summarizing this common pediatric disease process.  This episode will review the diagnosis of croup, how to risk stratify kids with croup, and how to treat and disposition them properly.  Most of the time, kids with croup do just fine with a little cold night air and some steroids but this episode will also help you figure out which kids are sicker and need much more attention and care.

Croup podcast

Croup Show Notes (Word Format)

Croup Show Notes (PDF)

Please visit our bandwidth sponsor EB Medicine.  They even have a review of Croup on their website- you can download a free copy here.  Residents can get free access while attendings can get a great discount at the EB Medicine EM Basic page.

Orthopedic Emergencies Inservice Review Screencast

These three screencasts were originally made for the Emergency Board Review podcast back in 2012 but they are still useful and relevant for the upcoming inservice exam at the end of the month.  Each screencast will review common orthopedic injuries and emergencies in a stepwise fashion.  Part 1 includes injuries to the Thorax and upper extremities, Part 2 covers the wrist and hand, and Part 3 discusses pelvic injuries, lower extremity injuries, and a brief review of pediatric ortho topics.

Even though these are screencasts, even if you can just listen to them, you’ll pick up some valuable information on these injuries.

Part 1- Thorax and Upper Extremities

Part 2- Wrist and Hand

Part 3- Pelvis, Lower Extremities, Pediatric Ortho Topics

Please take some time to visit our bandwidth sponsor, EB Medicine where residents can get free access and attendings can get discounts on their CME materials at the EM Basic page

Hypothermia by Dr. Andrea Sarchi

Just in time for the midway point of the winter season, this is a podcast on management of hypothermia in the ED.  Dr. Andrea Sarchi wrote the script which was recorded by Jacob Schriner, a second year medical student at Emory University School of Medicine.  In this episode we’ll review the basics of hypothermia diagnosis, history and physical exam pearls, treatment and disposition of these patients.  As always we’ll start with the “not sick” patient and then work our way up to the critically ill patients.

Hypothermia by Dr. Andrea Sarchi

Hypothermia Show Notes (PDF)

Hypothermia Show Notes (Word Format)

Please visit our bandwidth sponsor EB Medicine for free access for EM residents and great discounts for attendings at the EB Medicine EM Basic page.

Opioids Part 2 by Dr Sheyna Gifford

In part 2, Dr Sheyna Gifford will discuss the how to differentiate opioid overdose from other causes of altered mental status, some special disposition situations (especially with methadone), and how we can quickly screen for opioid abuse and provide patients compassionate care, treatment, and referral.

Opioids in the ED part 2 with Dr. Sheyna Gifford

Opioids Combined Show Notes (PDF)

My standard opioid prescription speech for all patients:

I am prescribing you a strong pain medication called Norco (or Percocet, respectively- aka hydrocodone or oxycodone).  This medication can make you sleepy so don’t drive or drink alcohol when you are taking it because it can be very harmful if you do.  This medication also has Tylenol (acetaminophen) in it so don’t mix it with anything else that has Tylenol in it. Some people are having problems with these medications by becoming addicted to them.  To avoid this, I want you to only take this medication when your pain is so bad that you cannot function.  This may not take away all your pain- it will just take the edge off so you can function.  I want you to take it for as short of an amount of time as possible- if you only need this pain medication for 2 or 3 days and you have leftover pills, I want you to throw out your pills in the trash.  Don’t save them for another time and don’t give them to anyone else.  Please keep them locked up and away from the reach of children, teens, or anyone else who has issues with addiction.

Please visit our bandwidth sponsor EB Medicine.  Residents and attendings can both get special offers from EB Medicine by visiting the EM Basic page.