Surviving Sepsis Campaign Puns

(1) In children who present as acutely unwell, we suggest implementing systematic screening for timely recognition of septic shock and other sepsisassociated organ dysfunction (weak recommendation, very low quality of evidence) Remarks: systematic screening needs to be tailored to the type of patients, resources, and procedures within each institution. Evaluation for the efectiveness and sustainability of screening should be incorporated as part of this process

(2) We were unable to issue a recommendation about using blood lactate values to stratify children with suspected septic shock or other sepsis-associated organ dysfunction into low-vs high-risk of having septic shock or sepsis

(3) We recommend implementing a protocol/guideline for management of children with septic shock or other sepsis-associated organ dysfunction (BPS)

(4) We recommend obtaining blood cultures before initiating antimicrobial therapy in situations where this does not substantially delay antimicrobial administration (BPS) Antimicrobial therapy

(5) In children with septic shock, we recommend starting antimicrobial therapy as soon as possible, within 1 h of recognition (strong recommendation, very low quality of evidence)

(6) In children with sepsis-associated organ dysfunction but without shock, we suggest starting antimicrobial therapy as soon as possible after appropriate evaluation, within 3 h of recognition (weak recommendation, very low quality of evidence)

(7) We recommend empiric broad-spectrum therapy with one or more antimicrobials to cover all likely pathogens (BPS)

(8) Once the pathogen(s) and sensitivities are available, we recommend narrowing empiric antimicrobial therapy coverage (BPS)

(9) If no pathogen is identifed, we recommend narrowing or stopping empiric antimicrobial therapy according to clinical presentation, site of infection, host risk factors, and adequacy of clinical improvement in discussion with infectious disease and/or microbiological expert advice (BPS)

(10) In children without immune compromise and without high risk for multidrug-resistant pathogens, we suggest against the routine use of empiric multiple antimicrobials directed against the same pathogen for the purpose of synergy (weak recommendation, very low quality of evidence) Remarks: in certain situations, such as confrmed or strongly suspected group B streptococcal sepsis, use of empiric multiple antimicrobials directed against the same pathogen for the purpose of synergy may

The more reading I'm doing the more that I'm finding out there to discredit this movement. Anything protocol driven naturally raises a brow for me, but with the PROCESS study there's some good data out there to say we aren't doing anything beneficial with this cookie cutter medicine.

What do you all feel?

Highlights:

-MAP >65mmHg-unchanged. I wonder if this plays out in the OR too?

-Still give 30ml/kg between 3 hours, but now weaker evidence.

-Stress dose steroids probably help and are recommended

-Balanced crystalloids > NS. This is a move I think has been gaining traction for years but glad to see SCCM finally saying it. Probably the biggest update.

-Vitamin C is no bueno. I guess we all saw this coming anyway.

That is all. Have a nice day.

The past few runs I've had I die of sepsis after reaching the city. No matter what treatment I try I can't seem to survive it. I've used the nano medkit, anti biotics, resting by a fire, staying well fed, etc. Is there some secret way I could survive this? It's been the only real thing ending my runs as of late. Thanks in advance

This was in March. I had a backache. It started out mild, but then got worse. I went to the doctor and she gave me muscle relaxants and ibuprofen. I woke up in the night vomiting what looked like coffee grounds. Was told by nurse on the phone to go to the ER, so I did.

At the ER, they noted my pain and did a bunch of tests and admitted me. Notably, the tests did not include an MRI. I was there for a couple of days-- I felt like I was giving birth out my back. Morphine did nothing, which made them suspect I was drug-seeking. Baclofen (muscle relaxer) helped some, so I switched to that instead.

They discharged me and told me to get a gastric scope to see what caused the blood I was throwing up and told me to go back to my primary care doctor, which I did, three days later. During those three days I was unable to sleep or relieve the pain in any way. I was starting to act really, really weird, too. Back at the primary care doctor, she said, "You need to be taken in an ambulance to the hospital."

When I got there, I no longer recognized my partner. Then I lost consciousness. They intubated me and I stayed intubated for about 10 days. I was very close to death as my organs started failing.

They finally figured out I had a spinal epidural abscess, cause by a rampant staph infection that turned septic. We still have no idea how I got it. I didn't have any wounds on me or anything. They operated, sucked out all the pus, and gave me HELLA antibiotics. They didn't know what I would be like when I woke up-- there was the possibility I would be paralyzed or have brain damage.

I spent three weeks in the hospital. I'm alive. I'm not paralyzed. I have some permanent eye damage and some damage to my larynx from the intubation, but otherwise I'm physically ok.

But psychologically...I had terrible, frightening delusions in the ICU. Plus, the knowledge that I almost died haunts me, particularly since we don't know what caused the initial infection. I've been working with a therapist, but it is a slow recovery. Much love to all of you out there recovering from sepsis.

Nothing immerses me as much as switching on ironman. And nothing bums me out more than the death of a pilot I started to identify with.

What's the longest you guys survived? :)

Flashback to memorial day weekend, I got a skin infection from a hot tub that led to a hospitalization for sepsis. Honestly haven’t felt the same since, despite recovering rapidly enough to return to work within a week of the sepsis spell.

Was finally getting back into working out again when I caught COVID-19 a month and a half ago. Apparently I’m one of the lucky vaccinated folks that somehow is having “long” Covid. I randomly start feeling sick again, and going out to socialize completely wipes me and makes me feel sick now.

I’m relatively young and health conscious, so those around me think I’m exaggerating or being a baby about how worn down I feel physically (and tbh mentally). My boyfriend is more social than me, and when I’m too tired to want to go see friends, it’s hard to get him to really grasp how low energy I’m feeling ; it’s not a mood thing as much as an “I’m going to fall asleep there” type of feeling. I’ve missed work a lot and they’re being understanding but I feel guilty for still being so under the weather.

I don’t want to get the flu shot or booster because my immune system already feels on overdrive (allergies and asthma and eczema have been flaring a lot more heavily since both of these illnesses).

I just want to be healthy again. I stopped working out and I’ve gained weight and I want to crawl into bed as soon as I get off of work. I’m balancing work and graduate school already and wish I also wasn’t balancing an extra need for physical rest.

So, I have been a DM for about 5 years now. I’ve ran multiple campaigns and I decided to home brew one set in Japan. It had references to Japanese culture, mythology, and yes anime (for the weebs in my group including me). I decided from the beginning to include a “twist villain” despite the cliché. The whole campaign they didn’t find the real villain working in the shadows. She was a powerful sorceress, and relatively helpful to the party.

She was using her husband, the “fake” villain of the campaign as a pawn to secure political power over the region. She is a Kitsune, (basically a Doppelgänger) and she wanted her people to not live in fear anymore, as the new empress of the region she could make life easier for them.

To do this she set up her husband with power to threaten the land then pose as the parties “guiding light” to win the people over when her husband is killed. She didn’t want to just hostile take over, she wanted to do this with minimal bloodshed for the protection of her people.

Last session rolls around and her plan comes into action. She gives her speech to persuade the capital city folk that the current emperor was not fit for rule since the land was in ruin. Ever since she joined the court, the evil forces where starting to be vanquished under her “direction” and that she should be in power due to the fact that she has been nothing but helpful by working with the party.

It was working. Until my players wanted to put a stop to this. Some debate happens while she is giving her speech and I thought “great, this is amazing RP”. Until the monk and the cleric hatch a plan. You see, her true form is a 9 tailed fox person, and she uses magic to hide it. Non verbally may I add, the cleric and monk decided to dispel the magic surrounding her true form to reveal her to the city. The cleric pulls out a ring of spell storing from earlier in the adventure which has a 5th level dispel magic in it. And she uses it. I make her roll and since there’s no “spell level” I decide to make it a 50/50 (this was my mistake I shoulda set it higher). DC 11 she rolls an 11. Fuck.

Now with her plan exposed, this high level final boss designed for 6 level 20’s (there was a second half we where gonna play at a future date) is exposed to the town. Her plan torn to shreds she transforms into her final form. Blows up the town, kills the party, and destroys the world.

TLDR; don’t put your twist villain in-front of your party. And use higher DC’s

EDIT: I know

I'm starting in the ICU next week and I was advised to read up on the surviving sepsis guidelines. I can only find that long PDF that is from 2012 (read this back in med school). Is there a newer one or is this the correct one to read? Via google search, I found that there were updates in 2016 but could only find a power point of it rather than a PDF. Can anyone please point me in the right direction? Thanks

I thought I was in the clear. He was leavinge alone. I was starting to name, validate, and process the emotional, physical, and sexual abuse he inflicted upon me. I was eating and sleeping again. My smile came back. And then BAM. Six weeks after I escaped the relationship, he slapped me with the smear campaign. We work together, and he decided to tell "his side of the story" to everyone. He's saying I owe him money and am refusing to pay (which is laughable considering how financially generous I was). He's bringing up and miscasting details of my personal life and previous marriage. It is humiliating. It is maddening. And I can't wrap my mind around the nerve he has to cast himself as the victim after abusing and terrorizing me in so many ways.

The other day, he harassed me at work in front of two coworkers (women) and a group of children we were working with. It was incredibly threatening and inappropriate. He got in my face, said he'll leave me alone if I paid the money, and followed me as I tried to walk away. I said, "I'm not doing this," and "I need you to walk away from me." Finally, I hid behind my coworker as she gathered the children to leave the area. He gave me that terrifying hard stare as we left. She was appalled and asked me if she could tell the supervisor. It was such a great relief to have validation, the first person to see or know the abuse. He got a stern warning from the supervisor, but he didn't get fired. I'm realizing it's time to do the hard thing I've been avoiding and get a restraining order.

How do you survive the smear campaign? I'm absolutely blown away by how convicted he is on his position. He has absolutely no leg to stand on, and he can take it to court if he wants, but I'm still afraid. I'm so upset, I want to tell everyone at work everything that happened, but I know it will only fuel his fire. It's so hard to manage my own emotions about this. I was just beginning to get out of the fog, and now he's publicly gaslighting and undermining me. It's a huge setback in my process. I'm sleeping worse than ever, and I can't stop the rumination.

Any words of wisdom or encouragement? If it happened to you, how long did it last? Did it ever stop? Thanks everyone, I'm falling apart, and I really appreciate your support.

Anyone else think Warhammer 3's Campaign will play similar to Total War: Attila? Whereas Warhammer 1 is about empire-building and Warhammer 2 is a race against time, CA describes Warhammer 3's campaign as a game of survival.

That reminds me of Total War: Attila which plays differently from past games, meant to give veteran players a challenge where they must focus less on Empire-building and more on fortifying their most advantageous positions to prepare for the incoming apocalypse, the Hun invasions.

This is especially most noticeable in Western Rome's campaign in Total War: Attila where you are literally encouraged to give up your Northern European territories in order to fortify your defenses in the Italian peninsula against the Huns and Barbarian Kingdoms to the north. Once you've rebuilt a stable economy and stronger forces in the heart of you're territory, you emerge from the Apocalypse to rebuild your Empire and see what other Kingdoms have survived or perished to the Huns. I do wonder how they'll handle this as Total War: Attila is perhaps the hardest game in the Total War series because of it's focus on surviving the apocalypse.

just discovered the extent of the smear.Not surprised by any means but dealing with alot of mixed emotions. Most common is rage i wanted to know any tips or tricks on how to mitigate and minimize the lies they have already started.

A mother cat (she's been named Mama Star) had emergency surgery on Saturday, August 3rd the Animal Medical Center in NYC after being rescued by volunteers from an alley in East Harlem. With an estimated less than 10% chance of survival,(she had a prolapsed colon (AMC said it's the worst they’ve ever seen) fleas, 3 types of worms, she was extremely anemic from the parasites, running a high fever, and emaciated.)

After surgery, she was taken to City Vets and soon diagnosed with sepsis and doctors were now 99% sure that again, she would not make it. Despite the odds, this miracle kitty has pulled through and the prognosis is finally good! She is currently in ICU at City Vet on with around the clock care. With the help of donations, the outlook for this kitty is finally looking bright and despite the pain she’s obviously still in, she is very lovable and affectionate-- that leads us to believe that she was dumped and is definitely not a full on feral cat.

Donations are are still very much needed and 100% tax deductible and 100% go to this cat's medical treatment! And we appreciate any amount.

https://fundrazr.com/campaigns/bZdm2?utm_campaign=story-update&utm_medium=email&utm_source=08-2013

AND GOOD NEWS! Both kittens have been ADOPTED and will be going home next week!!!