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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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Related Experiment Video

Updated: Oct 3, 2025

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Sepsis and Septic Shock: Evolving Evidence, Evolving Paradigms.

Andrew F Shorr1, Marya D Zilberberg2

  • 1Section of Pulmonary and Critical Care Medicine (AFS), MedStar Washington Hospital Center, Washington, District of Columbia.

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Summary

Sepsis and septic shock management involves timely antibiotics and fluid resuscitation. Balanced crystalloids are preferred over saline, and while hydrocortisone may aid shock reversal, more research on vasopressors is needed.

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Area of Science:

  • Critical care medicine
  • Infectious diseases
  • Emergency medicine

Background:

  • Sepsis and septic shock are critical, life-threatening conditions with evolving prevalence and microbiology.
  • Effective management is crucial due to significant morbidity and mortality.
  • Timely and appropriate antibiotic therapy remains the cornerstone of survival.

Purpose of the Study:

  • To review current evidence on sepsis and septic shock management.
  • To highlight evolving trends in prevalence and microbiology.
  • To discuss optimal resuscitation strategies and pharmacological interventions.

Main Methods:

  • Review of recent clinical trials and guidelines.
  • Analysis of data on fluid resuscitation, vasopressor use, and corticosteroid therapy.
  • Synthesis of information on evolving sepsis microbiology.

Main Results:

  • Crystalloids are the preferred initial resuscitation fluid, with balanced crystalloids showing superiority over 0.9% saline.
  • Optimal rates and timing for fluid resuscitation and vasopressor use remain subjects of ongoing debate.
  • Adjunctive hydrocortisone may accelerate shock reversal in septic shock, though its impact on mortality is debated.

Conclusions:

  • Prompt antibiotic administration is paramount for sepsis survival.
  • Fluid resuscitation strategies require careful consideration of fluid type and administration rate.
  • Further research is needed to clarify the role of newer vasopressors and the definitive impact of corticosteroids on septic shock outcomes.