Lisa Raumann

The Incredibly Useful, Hardly Ever Boring, Moderately Inspiring, but Somewhat Cynical Sepsis Presentation (Part A & B)

Are you tired of hearing about sepsis? You might be, but this is not that type of lecture. We will instead focus on the "why" of sepsis. Starting with pathophysiology, we will try to sort out screening issues, and procedure pathways, and talk about lactic acid and its association, or failed association, with poor oxygen states. We will talk about blood culture practices and antibiotic issues (is broad spectrum right for everyone, does timing matter?), as well as other assessment techniques to stratify risk. We will also talk about fluids, fluids, fluids (where did 30ml/kg come from?). This leads to a discussion of hemodynamics in the Emergency Department. With its fast-paced environment, is there time for that in the ED? Last, we will discuss fluid overload and medications in sepsis care.  At the end of this course, we will present a case study for review.  

LEARNING OBJECTIVES:
At completion of this session, the participant will be able to:

• Understand the physiology of fluid shifts in the volume-depleted patient and those with distributive injury.
• ​Describe the basic pathophysiology of immune response and its effects on the vascular system.
• Identify the signs and symptoms in patients with volume depletion and those progressing to hypovolemic or distributive shock.
• Discuss the implicit bias of skin color and how it changes/impacts assessment techniques.
• Understand hemodynamics as it pertains to hypovolemic and distributive shock, including cardiac output and stroke volume index as well as its components of preload, afterload, and contractility.
• Assess and verbalize the treatment modalities for the levers of preload, afterload, and contractility to maximize cardiac output and stroke volume.
• Identify the most common hemodynamic medications used in shock and the proper use of each.

Lisa Raumann has been an ICU and ER nurse for 16 years.  She has recently become an ER educator at a large ER in Northern California.  She is married to a bossy ICU RN who knows everything and is impossible to give household reports to.  She has two boys who are the most amazing kids ever (no bias)