More or Less: Sepsis, Shock, Stroke, and Staying Dry in Heart Failure

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This week on The Rounds Table Kieran and Mike are back with another rapid fire episode: just the salient points from four articles instead of two.

Guidelines recommend the use of hydrocortisone in patients with septic shock if adequate fluid resuscitation and treatment with vasopressors does not restore hemodynamic stability; however, current guidelines classify this recommendation as weak on the basis of the low quality of available evidence. Mike covers an RCT which investigates whether hydrocortisone reduces mortality among patients with septic shock.

Next, most people believe that a decrease in GFR in the setting of aggressive diuresis for CHF reflects a renal tubular injury. Mike takes listeners through an article which adds evidence to this belief using biomarkers to define tubular injury.

Kieran then takes the lead and guides listeners through an article examining whether the presence of short run atrial tachyarrhythmias increases the risk of stroke, and whether or not this can be predicted by the CHADS-Vasc score.

Lastly, Kieran covers the TARDIS trial. The trial investigates whether triple antiplatelet therapy in the setting of recent stroke reduces the incidence or severity of stroke or TIA within 90 days of the initial event

Finally, the Good Stuff segment. Mike covers a shortage of normal saline in the United States, and Kieran covers zombie viruses in the thawing permafrost.

What do you think of the Rapid Fire format? Let us know on Twitter @roundstable. Tweet at Kieran directly @kieranlquinn and Mike @FralickMike

The Papers

1. Steroids & Shock: http://www.nejm.org/doi/full/10.1056/NEJMoa1705835

2. Diuresis and Tubular Injury: http://circ.ahajournals.org/content/early/2018/01/17/CIRCULATIONAHA.117.030112.long

3.Tachyarrhythmias & Stroke: http://stroke.ahajournals.org/content/48/12/3232

4. TARDIS: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32849-0/fulltext

Good Stuff

1.Normal Saline Shortage: http://protomag.com/articles/after-storm

2. Zombie Viruses: https://www.npr.org/sections/goatsandsoda/2018/01/24/575974220/are-there-zombie-viruses-in-the-thawing-permafrost

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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