Since this video was posted, there was a credible claim made that the data supporting high dose vitamin C in sepsis had been fabricated, however, an investigation by CHEST found no evidence of fabrication. Nevertheless, subsequent RCTs that have looked at vitamin C in sepsis have found no benefit. I do not personally advocate for using vitamin C in sepsis.
Dr. Strong, you're the man! Wish you had videos about every main topic from each speciality, but for working at the hospital, these videos really help organize the work process by giving a clear structure to the things we're just "used to doing".
I had Septic Shock due to Pneumonia and respiratory distress (I had to be intubated for 3 days and nights) which led to the loss of my kidney transplant and almost my life. I now am on HemoDialysis and have weakened lungs. This was about 2 years before Covid-19 came about. The docs kept me on my immunosuppressants to keep my antibodies low for my next kidney transplant but I have so much scar tissue it will probably be my last and I am not even 50 yet.
I was told I had a "septic shower". I didn't know I had pneumonia in 2 areas of my right lung. I started shivering, couldn't get warm. Then started violently shaking. Mouth went totally dry. Shaking too badly to hold onto a phone to call an ambulance. Kept dropping a cup when I tried to drink water. When I was able to get some water down, I immediately vomited it back up. Felt myself starting to get light-headed so I laid on the floor in the "coma" position. Slowly lost consciousness or fell asleep (not sure which). When I came to, 40 minutes had passed from initial shivering to waking up on the floor. No longer vomiting or shaking but still felt nauseous. I thought something had poisoned me. Went to a doctor the next day and had x-rays on chest. He told me I had pneumonia and it caused me to have a septic shower by "smashing" the infection in my lung into my blood stream. Treated me with 2 courses of different antibiotics. It was terrifying, as I thought I was about to "step into eternity".
My baby sisyer just passed away from sepsis on December 19th, 2023😢😢...4 days later her son who was 29 passed away from lunĝ cancer! Very tuff stuff...😢...then my father in law passed away January 7th 2024! Crazy sad hard days!
Thank you for sharing your immense knowledge through very clear and objective classes. Particularly I loved to know that lactate in sepsis could be the result of intrinsic beta-agonists. These beta-agonists would be adrenaline? I think the relation between sepsis and lactate deserves its own video!
If we gave norepinephrine but still unresponsive do we increase the dose of norepinephrine or we are gonna add an inotropic? Which one is better according to the guidelines or is there any guideline that mentions this situation?
Sir I love your videos and have been able to use your videos in daily medical practice. I would love to show my gratitude and support. Plus i was also wondering if you could make a video on MRI reading since I am utterly weak at it. Thank you
Excellent video! I just wanna know when we should use antifungals, e.g. micafungin .. from the beginning of cases like neutropenia, depending on tests like procalcitonin, or just after non-improvement on antibiotics ? Also, are there any mechanism(s) that IV vitamin C could play a role ??
Why is fever not a part of sofa and qsofa? Also, many conditions, eg hypovolemia, can have low BP, altered mental status. They also fulfil the criteria of qsofa. How is qsofa better than SIRS?
These are good questions. In the initial version of this video, I talked a little about the limitations of qsofa and why it might not actually be that great, but cut it out for time ;watching it again just now I realize that the edit makes me come across as endorsing qsofa a little more than I actually do IRL. One distinction between qsofa and SIRS is that SIRS was literally part of the definition of sepsis (i.e. a person had to meet 2+ of the 4 SIRS criteria to be labeled as having sepsis), but qsofa is just a screening tool. Regarding the lack of fever in the criteria - I agree it's surprising; I can't immediately find an explanation for its absence but I would guess it made the screening tool too sensitive (i.e. picking up lots of patients with only mild infections).
my one and only brother died because of septic shock. doc couldn't find out the infection in time. after a heamorroid operation my brother died. there was a fault in operation and after operation there developed paritonitise and he went to septic shock. but doc couldn't find the paritonitise in time.
@@shubhamsaini9059 sorry for you sister. my whole family are still traumatized including me. my brother was a PhD holder. he received his PhD after his death. for the negligence of a doctor my brother died.
d/c or alternatively, dc = discontinue (or when referencing a patient, discharge). Sorry - it's a very common medical abbreviation in the US, but apparently not everywhere!
Does a deep cut hand cause sepsis? , I got a deep cut on my hand from a normal size of knife while chopping onion. I went to a doctor and he said you will need blood, I have taken 1 unit of blood and one more to take. I have been suffering from fever from 102°F to 106° from the last 20 days. Is it sepsis?
OMG. I’m in trouble. Abscess for about 13-16 years, infection above where I’m keeping it at bay (on x ray) vega test showed years ago, my body is too weak to tolerate most dental materials, and anaesthetics, I’ve a 21 year old caesarean scar that they let me leave hospital with an infection (which is a mess because they had to save my life, as left to take my last breath being in and out of unconsciousness having my daughter and had ruptured both ways), had gall bladder out in 2017 and still sharp pain and gets worse at times as if infected or not done properly (ignored on pain) was told i had the highest inflammation drs had ever seen at the surgery some years back (no treatment offered, sent home), was told about 5 years ago when i finally got appt for gp regarding gall bladder pain “never mind that, you’ve got pneumonia (again no advice - sent home), before that every time i got a cold it would culminate in me barking violently days to weeks after and bits of blood, they didn’t want to know. Now i have been left by dentist with no fillings put back on since November last year, now in pain and just rotting feeling dizzy, confused, in a lot more all over pain than just the fibromyalgia, and due to vega test cannot get anyone to understand or treat me, and with widespread candida, i dont even want to try anymore. I dont have the money or help, as NHS dont want to hear about vega tests. My water retention is worse, everythings worse, the pain wont leave my legs, its like ton weights on them, i feel there’s a problem with adrenals/kidneys but have lost trust in NHS. Tonight my pain down my face, and my throat feels like my thyroids really bad. My ears hurt/waxy too. I’m in midlands, England.
Back in 2018 I had sepsis and I was minutes away from death and I'm not even exaggerating. I remember I'd actually been feeling shity for a few days couldn't figure out what was wrong with me I was so fatigued and exhausted that even just getting up I'm going to the bathroom was too much funny enough getting up and going to the bathroom is what saved me I forced myself up and I Remember by the time I got back to my bed my heart was really hurting and at that moment I had two choices I could have gone to bed and hoped the next day would be better but for some reason I decided to dial 911 told them is that my heart was hurting so the ambulance picked me up took me to the hospital I had never gotten such Quick Service in the ER it was almost as though I got there they took the blood sample and 10 or 15 minutes later the doctors in there telling me I am severely anemic and I have sepsis and endocarditis then they admitted me the next morning I ordered breakfast took one bite and that was it I don't remember much except for waking up in the ICU because I had a stroke! I was amazingly lucky that I made the right choice because if I would have waited and just gone to bed the next morning I would have been here all alone everybody would have been gone for a week and I'm sure they would have come home to me dead on the floor but I did make the right decision when I first called 911 the fact that I knew the next morning I'd wake up and be here alone was part of the reason I decided I better call now and just get checked out I'm sure I'm okay but then I ended up having to spend 3 months in a Recovery Center. I was literally on my deathbed and I remember I even said to the doctor I was considering waiting until next week the doctor said that if I would have waited even another couple hours I would have been dead so I shouldn't have waited in their glad I decided to come in. There was one weird thing I'm not sure why it happened but when the ambulance picked me up they couldn't prick my finger and read my sugar levels it would just keep not reading the ambulance guy says he'd seen it before and it was somebody that was anemic so he thinks I'm probably anemic and honestly I wish that was all it was
A 68-year-old woman suffering from sepsis is hospitalized in the internal ward and is being treated in antibiotics and antipyretics. During her examination this morning, she was sleepy, vital signs Within the scope of the norm, breathing on her own, with no unusual findings on physical examination. Suddenly the monitor beeps due to a drop in storage. The patient is tachypneic and tachycardiac. What is the first step to be taken? 1) Connecting the patient to oxygen goggles 2) Intubation 3) Observing the oral cavity and suctioning secretions when necessary 4) Gas test to diagnose the source of distortion
hello, how do we know how much fluid bolus and maintenance fluid to give to each patient? I know its 30ml/kg bolus, is the kg based on ideal or actual body weight?
@@StrongMed Hello, I've been diagnosed with folliculitis since 2013 caused by staphylococcus infection. I also had furnacles & fear that I may have Sepsis. I heard that this is a uncurable deadly disease & I'm afraid to die from this. I don't know what to do.
It's a free audio clip that's made available for creators by RUclips. Its name is Thor's Hammer, by Ethan Meixsell (www.ethanmeixsell.com/ ). His style is a little eclectic.
There was not statistical difference in the primary outcomes of change in modified SOFA score at 96hrs, plasma biomarkers of inflammation , nor plasma biomarkers of vascular injury - there was no improvement in organ dysfunction
Qsofa i have 1 point which is mental confusion. I have a bad tooth infection for about a year now. I think I'm going to die. I heard tooth absese can cause sepsis please helo
Yes, when severe and/or when they involve particularly virulent organisms, tooth abscess can progress to sepsis. I'm very sorry that I can't give you specific, individualized medical advice on here, but if you think you have a non-resolving dental abscess, I strongly recommend you see a dentist.
Thank you for the feedback, but the intended audience for the video is healthcare professionals and senior medical students who would already be familiar with any terms not defined within the video itself.
Im in a bad way i have undiagnosed and untreated sepsis. If im alive tomorrow im driving straight to the er and begging for my life ! Its been 3 weeks of this!!
I usually don't give specific, individualized medical advice on here.... However, if you think you have sepsis, you should get to the ED immediately! Also, if you are feeling that ill, it's much better for a friend or ambulance to drive you than for you to drive yourself.
@@StrongMed ok thankyou. I do feel too sick to drive im weak and dizzy and very fatigued. Its a different feeling than being sick from the cold of flu. I appreciate your reaponse and advice. I will give an update hopefully with a happy ending.
Since this video was posted, there was a credible claim made that the data supporting high dose vitamin C in sepsis had been fabricated, however, an investigation by CHEST found no evidence of fabrication. Nevertheless, subsequent RCTs that have looked at vitamin C in sepsis have found no benefit. I do not personally advocate for using vitamin C in sepsis.
Dr. Strong, you're the man! Wish you had videos about every main topic from each speciality, but for working at the hospital, these videos really help organize the work process by giving a clear structure to the things we're just "used to doing".
Thank you Dr. Strong. You are one of the best lecturers I've seen on RUclips.
Completely right
What a brief, yet a detailed way of expression. I sincerely congratulate you.
I had Septic Shock due to Pneumonia and respiratory distress (I had to be intubated for 3 days and nights) which led to the loss of my kidney transplant and almost my life. I now am on HemoDialysis and have weakened lungs. This was about 2 years before Covid-19 came about. The docs kept me on my immunosuppressants to keep my antibodies low for my next kidney transplant but I have so much scar tissue it will probably be my last and I am not even 50 yet.
Hope so you recover soon my mother passed 🙏 few days back due to covid and septic shock
🙏🙏🙏 prayers for you
How are you now?
Thank you for in-depth explanation about sepsis and what to do for it. I appreciate that.
Hello from New Delhi, i work in ER and this video help me and strengthen my knowledge
Thank you Dr Strong. This is my second time watching this lecture. It is great.
Well presented, pitch perfect lecture! Thank you Dr Strong for all you do, much appreciated.
Beautiful overview! Great work, dr. Strong!
Thank you Dr Strong , wonderful lecture and to the point. Definitely a must for intern .
I was told I had a "septic shower". I didn't know I had pneumonia in 2 areas of my right lung. I started shivering, couldn't get warm. Then started violently shaking. Mouth went totally dry. Shaking too badly to hold onto a phone to call an ambulance. Kept dropping a cup when I tried to drink water. When I was able to get some water down, I immediately vomited it back up. Felt myself starting to get light-headed so I laid on the floor in the "coma" position. Slowly lost consciousness or fell asleep (not sure which). When I came to, 40 minutes had passed from initial shivering to waking up on the floor. No longer vomiting or shaking but still felt nauseous. I thought something had poisoned me. Went to a doctor the next day and had x-rays on chest. He told me I had pneumonia and it caused me to have a septic shower by "smashing" the infection in my lung into my blood stream. Treated me with 2 courses of different antibiotics. It was terrifying, as I thought I was about to "step into eternity".
Excellent video including both SIRS and SOFA.. Sincere thanks Dr Strong..
Excellent video, some of the best medical content out there, much appreciated Dr Strong 💪🏼
Very understandable and clear and concise lecture. Awesome .
Ευχαριστούμε!
My baby sisyer just passed away from sepsis on December 19th, 2023😢😢...4 days later her son who was 29 passed away from lunĝ cancer! Very tuff stuff...😢...then my father in law passed away January 7th 2024! Crazy sad hard days!
Sorry for your loss
Sorry to hear about your loss
Thank you for sharing your immense knowledge through very clear and objective classes. Particularly I loved to know that lactate in sepsis could be the result of intrinsic beta-agonists. These beta-agonists would be adrenaline? I think the relation between sepsis and lactate deserves its own video!
I'm a surgery resident and find your videos very helpful n amazing. I look forward to get more n more updated videos
your channel is a gold mine of information ... thx a lot !!
Comprehensive and terse. Excellent.
You get an A !
good sir ....never understood concept better than this
Great information as always! Thank you for your work
Such a great video and explanation. Thank you Sir.
If we gave norepinephrine but still unresponsive do we increase the dose of norepinephrine or we are gonna add an inotropic? Which one is better according to the guidelines or is there any guideline that mentions this situation?
I think my issue with the qSOFA is that there are many things that could give a pt even a score of 3.
Sir I love your videos and have been able to use your videos in daily medical practice. I would love to show my gratitude and support. Plus i was also wondering if you could make a video on MRI reading since I am utterly weak at it. Thank you
Very helpful, what your thoughts on Qsofa?
Adding chapters to the video would help a lot.
Can we study the chemical composition of sepsis infections
Excellent video! I just wanna know when we should use antifungals, e.g. micafungin .. from the beginning of cases like neutropenia, depending on tests like procalcitonin, or just after non-improvement on antibiotics ?
Also, are there any mechanism(s) that IV vitamin C could play a role ??
Awesome video as always
thank you Dr. Strong!
First time that I do this, thank you for this excellent content
You're very welcome!
what a thorough scientific timeline on sepsis
you are really fabulous
The best strong 💪 medicine 🙌
Appreciate the course Eric!
Thank you I've learn a lot
Great resource! Well done Dr. Strong.
Why is fever not a part of sofa and qsofa?
Also, many conditions, eg hypovolemia, can have low BP, altered mental status. They also fulfil the criteria of qsofa. How is qsofa better than SIRS?
These are good questions. In the initial version of this video, I talked a little about the limitations of qsofa and why it might not actually be that great, but cut it out for time ;watching it again just now I realize that the edit makes me come across as endorsing qsofa a little more than I actually do IRL. One distinction between qsofa and SIRS is that SIRS was literally part of the definition of sepsis (i.e. a person had to meet 2+ of the 4 SIRS criteria to be labeled as having sepsis), but qsofa is just a screening tool. Regarding the lack of fever in the criteria - I agree it's surprising; I can't immediately find an explanation for its absence but I would guess it made the screening tool too sensitive (i.e. picking up lots of patients with only mild infections).
@@StrongMed Thank you for the reply and for guiding me throughout the med school with your videos!
thank you doctor, i appreciate your work
my one and only brother died because of septic shock. doc couldn't find out the infection in time. after a heamorroid operation my brother died. there was a fault in operation and after operation there developed paritonitise and he went to septic shock. but doc couldn't find the paritonitise in time.
Meri di k sath bhi yahi hua bhai...
@@shubhamsaini9059 sorry for you sister. my whole family are still traumatized including me. my brother was a PhD holder. he received his PhD after his death. for the negligence of a doctor my brother died.
D/c at 12:38 means ?
d/c or alternatively, dc = discontinue (or when referencing a patient, discharge). Sorry - it's a very common medical abbreviation in the US, but apparently not everywhere!
Does a deep cut hand cause sepsis? , I got a deep cut on my hand from a normal size of knife while chopping onion. I went to a doctor and he said you will need blood, I have taken 1 unit of blood and one more to take. I have been suffering from fever from 102°F to 106° from the last 20 days.
Is it sepsis?
I'm sorry but I cannot offer specific, individualized medical advice here.
Excellent video.
Very nice lecture 🌸💛,hope you well ever
OMG. I’m in trouble. Abscess for about 13-16 years, infection above where I’m keeping it at bay (on x ray) vega test showed years ago, my body is too weak to tolerate most dental materials, and anaesthetics, I’ve a 21 year old caesarean scar that they let me leave hospital with an infection (which is a mess because they had to save my life, as left to take my last breath being in and out of unconsciousness having my daughter and had ruptured both ways), had gall bladder out in 2017 and still sharp pain and gets worse at times as if infected or not done properly (ignored on pain) was told i had the highest inflammation drs had ever seen at the surgery some years back (no treatment offered, sent home), was told about 5 years ago when i finally got appt for gp regarding gall bladder pain “never mind that, you’ve got pneumonia (again no advice - sent home), before that every time i got a cold it would culminate in me barking violently days to weeks after and bits of blood, they didn’t want to know. Now i have been left by dentist with no fillings put back on since November last year, now in pain and just rotting feeling dizzy, confused, in a lot more all over pain than just the fibromyalgia, and due to vega test cannot get anyone to understand or treat me, and with widespread candida, i dont even want to try anymore. I dont have the money or help, as NHS dont want to hear about vega tests. My water retention is worse, everythings worse, the pain wont leave my legs, its like ton weights on them, i feel there’s a problem with adrenals/kidneys but have lost trust in NHS. Tonight my pain down my face, and my throat feels like my thyroids really bad. My ears hurt/waxy too. I’m in midlands, England.
I hope your doing better😢
Thanks sir awsom review strong narration r always strong!
Excellent, many thanks
Back in 2018 I had sepsis and I was minutes away from death and I'm not even exaggerating. I remember I'd actually been feeling shity for a few days couldn't figure out what was wrong with me I was so fatigued and exhausted that even just getting up I'm going to the bathroom was too much funny enough getting up and going to the bathroom is what saved me I forced myself up and I Remember by the time I got back to my bed my heart was really hurting and at that moment I had two choices I could have gone to bed and hoped the next day would be better but for some reason I decided to dial 911 told them is that my heart was hurting so the ambulance picked me up took me to the hospital I had never gotten such Quick Service in the ER it was almost as though I got there they took the blood sample and 10 or 15 minutes later the doctors in there telling me I am severely anemic and I have sepsis and endocarditis then they admitted me the next morning I ordered breakfast took one bite and that was it I don't remember much except for waking up in the ICU because I had a stroke!
I was amazingly lucky that I made the right choice because if I would have waited and just gone to bed the next morning I would have been here all alone everybody would have been gone for a week and I'm sure they would have come home to me dead on the floor but I did make the right decision when I first called 911 the fact that I knew the next morning I'd wake up and be here alone was part of the reason I decided I better call now and just get checked out I'm sure I'm okay but then I ended up having to spend 3 months in a Recovery Center. I was literally on my deathbed and I remember I even said to the doctor I was considering waiting until next week the doctor said that if I would have waited even another couple hours I would have been dead so I shouldn't have waited in their glad I decided to come in.
There was one weird thing I'm not sure why it happened but when the ambulance picked me up they couldn't prick my finger and read my sugar levels it would just keep not reading the ambulance guy says he'd seen it before and it was somebody that was anemic so he thinks I'm probably anemic and honestly I wish that was all it was
Are there other pressors you would recommend for a hypotensive patient who is also tachy?
A 68-year-old woman suffering from sepsis is hospitalized in the internal ward and is being treated
in antibiotics and antipyretics. During her examination this morning, she was sleepy, vital signs
Within the scope of the norm, breathing on her own, with no unusual findings on physical examination.
Suddenly the monitor beeps due to a drop in storage. The patient is tachypneic and tachycardiac.
What is the first step to be taken?
1) Connecting the patient to oxygen goggles
2) Intubation
3) Observing the oral cavity and suctioning secretions when necessary
4) Gas test to diagnose the source of distortion
You are one of a kind
my sister passed a few days ago no warning signs shut down completely was in icu 1 day they could not save her
Excellent video 👌
Very informative and interesting video...thanx
hello, how do we know how much fluid bolus and maintenance fluid to give to each patient? I know its 30ml/kg bolus, is the kg based on ideal or actual body weight?
Pours a cup off tea and kicks up feet
Ah, yes-It's strong medicine time.
Can someone explain what happens while you’re having a sepsis shock?
Thank you! 😊
Thanks so much .. when is the next video and what's it about?
Finally another ECG video...the subtypes of atrial flutter. Hoping to post it in 2-3 days.
That's really something .. ❤️
@@StrongMed Hello, I've been diagnosed with folliculitis since 2013 caused by staphylococcus infection. I also had furnacles & fear that I may have Sepsis. I heard that this is a uncurable deadly disease & I'm afraid to die from this. I don't know what to do.
Great job!
Very cool and relevat explained
Sir, how much you meant by high dose of Vit C ?
Great resource
What song is that in the outro? Thanks
It's a free audio clip that's made available for creators by RUclips. Its name is Thor's Hammer, by Ethan Meixsell (www.ethanmeixsell.com/ ). His style is a little eclectic.
So good!
thanks Eric
Thank you very much
God bless you
you are amazing
There was not statistical difference in the primary outcomes of change in modified SOFA score at 96hrs, plasma biomarkers of inflammation , nor plasma biomarkers of vascular injury - there was no improvement in organ dysfunction
hoooly shihheeet . this an amazing vid . thanks
Thank You so much sir
awesome as always. i have found diagnosis of sepsis is confusing.
Oh thnx now I understand sepsis
More thanks
I have lost my father😭😭😭due to medical negligence. Father i love you. My father name is Subhash Chandra Sarkar
Will pray for him
Thank you
Qsofa i have 1 point which is mental confusion. I have a bad tooth infection for about a year now. I think I'm going to die. I heard tooth absese can cause sepsis please helo
Yes, when severe and/or when they involve particularly virulent organisms, tooth abscess can progress to sepsis. I'm very sorry that I can't give you specific, individualized medical advice on here, but if you think you have a non-resolving dental abscess, I strongly recommend you see a dentist.
comprehensive!
Amazing❤️♥️☕
YOU ARE A MEDICAL GURU
Tremendous!
This would have more views if it had been presented in common terms and included explanations regarding the term meanings and their applications.
Thank you for the feedback, but the intended audience for the video is healthcare professionals and senior medical students who would already be familiar with any terms not defined within the video itself.
Tnx
you are legend
Sweet... well do e sir
Im in a bad way i have undiagnosed and untreated sepsis. If im alive tomorrow im driving straight to the er and begging for my life ! Its been 3 weeks of this!!
I usually don't give specific, individualized medical advice on here.... However, if you think you have sepsis, you should get to the ED immediately! Also, if you are feeling that ill, it's much better for a friend or ambulance to drive you than for you to drive yourself.
@@StrongMed ok thankyou. I do feel too sick to drive im weak and dizzy and very fatigued. Its a different feeling than being sick from the cold of flu. I appreciate your reaponse and advice. I will give an update hopefully with a happy ending.
@@StrongMed ok i went to the hospital and they sent me home to die with not even 1 test to check for sepsis besides basic bloodwork.
@@johnkimball5872 Hi dear. Are you okay?
Appreciate it
Hallelujah
Great
❤
Tsukasa brought me here
Put a T after the S and now it’s Stepsis
I lost my husband to sepsis
.
See? This is why Doctors are smarter than the rest of us. I keep getting lost in this lecture.
Thank you
thank you
Thank you