Podcast #120: The State of Sepsis in 1966

sepsisRun Time: 6 minutes

Author:  Christopher Holmes M.D.

Educational Pearls:

  • In 1966, sepsis was believed to be comprised of bacteremia, endotoxins and exotoxins, and disruption of capillary blood flow.
  • Risk factors were women who underwent “non-sterile abortions” (A common occurance before Row vs Wade in 1973) and being an “old” man over 40 y/o.
  • For work up, the standard practice was measuring the Central Venous Pressure (CVP) with a manometer by inserting a polyvinyl catheter via surgical cutdown in the basilic vein and using a tape measure to roughly gauge the distance of the column of water to the heart.
  • If CVP was low, blood and plasma were given along with isoproterenol (a beta-agonist) and digoxin (to increase contractility). If this failed, then phenoxybenzamine (an alpha-antagonist) was used to dilate the capillaries. At this point, norepinephrine was not used for treatment.
  • The antibiotics of the day were kanamycin, streptomycin, and chloramphenicol. These treatments were almost always used along with 60 million units of penicillin, the “go-to” antibiotic. Interestingly, every million units of penicillin has 1 milliequivalent of potassium, which is counter-intuitive to give to patients in possible renal failure from sepsis.
  • Steroids and permissible hypotension were in vogue as well, and pressors were supposed to be given only if a blood pressure was not palpable.

Link to Podcast: http://medicalminute.madewithopinion.com/state-of-sepsis-1966/

References:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403600/

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