Long Brit, Gottlieb Michael
Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
Am J Emerg Med. 2025 Apr;90:179-191. doi: 10.1016/j.ajem.2025.01.054. Epub 2025 Jan 22.
Sepsis is a common condition associated with significant morbidity and mortality. Emergency physicians play a key role in the diagnosis and management of this condition.
This paper evaluates key evidence-based updates concerning the management of sepsis and septic shock for the emergency clinician.
Sepsis is a life-threatening syndrome, and rapid diagnosis and management are essential. Antimicrobials should be administered as soon as possible, as delays are associated with increased mortality. Resuscitation targets include mean arterial pressure ≥ 65 mmHg, mental status, capillary refill time, lactate, and urine output. Intravenous fluid resuscitation plays an integral role in those who are fluid responsive. Balanced crystalloids and normal saline are both reasonable options for resuscitation. Early vasopressors should be initiated in those who are not fluid-responsive. Norepinephrine is the recommended first-line vasopressor, and if hypotension persists, vasopressin should be considered, followed by epinephrine. Administration of vasopressors through a peripheral 20-gauge or larger intravenous line is safe and effective. Steroids such as hydrocortisone and fludrocortisone should be considered in those with refractory septic shock.
An understanding of the recent updates in the literature concerning sepsis and septic shock can assist emergency clinicians and improve the care of these patients.
脓毒症是一种常见病症，伴有显著的发病率和死亡率。急诊医生在该病症的诊断和管理中发挥着关键作用。
本文评估了针对急诊临床医生的有关脓毒症和脓毒性休克管理的关键循证更新内容。
脓毒症是一种危及生命的综合征，快速诊断和管理至关重要。应尽快给予抗菌药物，因为延迟给药与死亡率增加相关。复苏目标包括平均动脉压≥65mmHg、精神状态、毛细血管再充盈时间、乳酸水平和尿量。静脉液体复苏在对液体有反应的患者中起着不可或缺的作用。平衡晶体液和生理盐水都是合理的复苏选择。对于对液体无反应的患者应尽早开始使用血管升压药。去甲肾上腺素是推荐的一线血管升压药，如果低血压持续存在，应考虑使用血管加压素，随后是肾上腺素。通过外周20号或更大的静脉留置针给予血管升压药是安全有效的。对于难治性脓毒性休克患者，应考虑使用氢化可的松和氟氢可的松等类固醇药物。
了解有关脓毒症和脓毒性休克的文献最新更新内容可帮助急诊临床医生并改善对这些患者的护理。
