title: Severe sepsis and septic shock: review of the literature and emergency department management guidelines.
abstract: Severe sepsis and septic shock are as common and lethal as other acute life-threatening conditions that emergency physicians routinely confront such as acute myocardial infarction, stroke, and trauma. Recent studies have led to a better understanding of the pathogenic mechanisms and the development of new or newly applied therapies. These therapies place early and aggressive management of severe sepsis and septic shock as integral to improving outcome. This independent review of the literature examines the recent pathogenic, diagnostic, and therapeutic advances in severe sepsis and septic shock for adults, with particular relevance to emergency practice. Recommendations are provided for therapies that have been shown to improve outcomes, including early goal-directed therapy, early and appropriate antimicrobials, source control, recombinant human activated protein C, corticosteroids, and low tidal volume mechanical ventilation.
authors.affiliation: Loma Linda University, Loma Linda, CA, USA.
authors.forename: H Bryant
authors.initials: HB
authors.lastname: Nguyen
authors.forename: Emanuel P
authors.initials: EP
authors.lastname: Rivers
authors.forename: Fredrick M
authors.initials: FM
authors.lastname: Abrahamian
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Moran
authors.forename: Edward
authors.initials: E
authors.lastname: Abraham
authors.forename: Stephen
authors.initials: S
authors.lastname: Trzeciak
authors.forename: David T
authors.initials: DT
authors.lastname: Huang
authors.forename: Tiffany
authors.initials: T
authors.lastname: Osborn
authors.forename: Dennis
authors.initials: D
authors.lastname: Stevens
authors.forename: David A
authors.initials: DA
authors.lastname: Talan
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D017410:Practice Guidelines as Topic; D011486:Protein C / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D012121:Respiration, Artificial; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D012772:Shock, Septic / Q000628:therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D002317:Cardiovascular Agents; D011486:Protein C; D011994:Recombinant Proteins; C421124:drotrecogin alfa activated