Hospital Medicine Alert – February 1, 2016

February 1, 2016

• Sepsis Resuscitation and Mortality

  The use of balanced salt solutions rather than isotonic saline or colloids may improve in-hospital mortality in patients admitted with septic shock.

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• Bedside Ultrasound: Is It a Reliable Tool for Guiding Resuscitation in Patients with Undifferentiated Hypotension?

  The use of bedside ultrasound has expanded tremendously over the last few decades. As it is readily available and relatively inexpensive, ultrasound provides the opportunity to examine hypotensive, critically ill patients, potentially leading to a faster, more accurate diagnosis.

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• Clinicians Are Skeptical of Early Warning Systems for Sepsis

  Severe sepsis is very common, with high morbidity and mortality. Early recognition and intervention improves mortality. However, the diagnosis may often be missed in early sepsis. An academic health system developed an electronic early warning and response system for sepsis in 2012, monitoring real time vital signs and laboratory data for hospitalized, non-ICU, acute care patients and notifying clinicians when specific criteria were met.

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• Spironolactone for Resistant Hypertension

  Resistant hypertension is common, and the choice of additional drug therapy in this condition is not clear.

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• Delay in Performing Endovascular Reperfusion Results in Worse Disability Outcomes

  In the past year, multiple clinical trials have reported that intra-arterial endovascular reperfusion with mechanical clot extraction, using the SOLITAIRE stent retriever device and others, results in better neurological outcomes than treating patients with intravenous thrombolysis alone with TPA. There is still uncertainty regarding the maximum time window, and how important early intervention is as related to neurological recovery and long-term outcomes.

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