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Sepsis

EASy Sepsis Protocol

POCUS-guided hemodynamic assessment and resuscitation in septic shock

What is EASy Sepsis?

EASy Sepsis applies the EASy MAP framework specifically to septic patients, guiding fluid resuscitation, vasopressor selection, and identifying sepsis-induced cardiomyopathy.

The protocol helps clinicians move beyond the “30 mL/kg for everyone” approach to personalized, hemodynamic-guided resuscitation.

Key Principles

  • Assess fluid responsiveness -- Not every septic patient needs more fluid
  • Identify cardiomyopathy -- Sepsis-induced cardiac dysfunction changes management
  • Monitor for congestion -- B-lines and IVC signal fluid overload
  • Serial assessment -- Hemodynamics change; reassess frequently

When to Use EASy Sepsis

  • Sepsis with hypotension (MAP < 65)
  • Septic shock requiring vasopressors
  • Unclear fluid responsiveness
  • Failure to respond to initial resuscitation
  • Concern for fluid overload

EASy Sepsis App

Interactive POCUS-guided sepsis resuscitation tool. Get real-time hemodynamic phenotype identification and treatment recommendations at the bedside.

EASy Sepsis Assessment

Systematic approach to the septic patient

1

Cardiac Function

Assess LV size and contractility

  • Hyperdynamic: Small cavity, vigorous squeeze - Typical sepsis
  • Normal: Adequate size and function - Early/resolving
  • Depressed: Dilated, poor squeeze - Septic cardiomyopathy

Action: If depressed - Consider inotropes (dobutamine), limit fluids

2

IVC Assessment

Evaluate volume status and fluid responsiveness

  • Small, collapsing (>50%): Likely fluid responsive
  • Normal, variable: May respond to fluid challenge
  • Plethoric, non-collapsing: Unlikely to respond, risk of overload

Action: If plethoric - Stop fluids, consider diuresis if congested

3

Lung Ultrasound

Assess for pulmonary congestion

  • A-lines (dry): No pulmonary edema, may tolerate fluids
  • B-lines (wet): Pulmonary edema present, limit fluids
  • Consolidation: Pneumonia source identification

Action: B-lines + plethoric IVC - Diuresis or ultrafiltration

4

Pleural Assessment

Check for effusions and source

  • Effusion present: May indicate volume overload or infection
  • Consolidation: Potential pneumonia source

Action: Large effusion causing respiratory compromise - Consider drainage

Sepsis Hemodynamic Phenotypes

Tailoring therapy based on ultrasound findings

Hypovolemic Sepsis

Fluid Responsive

Findings

  • Small hyperdynamic ventricles
  • Flat, collapsing IVC (>50%)
  • A-lines bilaterally

Management

  • Aggressive fluid resuscitation
  • Reassess after each bolus
  • Transition to vasopressors when filled

Resuscitated Distributive

Most Common

Findings

  • Hyperdynamic LV (small, squeezing)
  • Collapsing IVC
  • A-lines (dry lungs)

Management

  • IV fluids (if IVC collapsing)
  • Norepinephrine for vasodilation
  • Source control

Septic Cardiomyopathy

10-20% of Sepsis

Findings

  • Dilated LV with poor function
  • Plethoric IVC
  • B-lines (pulmonary edema)

Management

  • STOP fluids
  • Add inotrope (dobutamine, milrinone)
  • Consider diuresis if congested

RV Dysfunction

ARDS/PE

Findings

  • Dilated RV (RV/LV > 1)
  • Septal flattening
  • Plethoric IVC

Management

  • Limit fluids (may worsen RV)
  • Pulmonary vasodilators
  • Optimize ventilation

Fluid Overloaded

Post-Resuscitation

Findings

  • Normal or hyperdynamic LV
  • Plethoric, non-collapsing IVC
  • B-lines (>3 per field)
  • Pleural effusions

Management

  • No more fluids
  • Active diuresis
  • Consider ultrafiltration

Serial Assessment Protocol

Hemodynamics are dynamic -- reassess frequently

0h

Initial Assessment

Complete EASy Sepsis exam, identify phenotype, initiate targeted therapy

1-2h

Post-Resuscitation Check

Reassess IVC, check for developing B-lines, evaluate response to fluids/pressors

6h

Resuscitation Endpoint

Full reassessment - transition from resuscitation to de-resuscitation phase

24h

Daily Assessment

Guide diuresis, vasopressor weaning, identify septic cardiomyopathy recovery

Key Concept: De-Resuscitation

Once source controlled and hemodynamically stable, transition to removing excess fluid. Serial EASy exams guide safe diuresis by monitoring IVC and LV filling.

Practice with Sepsis Cases

Apply EASy Sepsis to challenging clinical scenarios