Impact of a Combination Antibiotic Bag on Compliance With Surviving Sepsis Campaign Goals in Emergency Department Patients With Severe Sepsis and Septic Shock.

BACKGROUND: Severe sepsis and septic shock represent common presentations in the emergency department (ED) and have high rates of mortality. Guideline-recommended goals of care have been shown to benefit these patients, but can be difficult to provide. OBJECTIVE: To determine whether the use of a premixed bag consisting of 2 g cefepime and 1 g vancomycin in 1000 mL of normal saline increases the probability of patients receiving Surviving Sepsis Campaign (SSC) recommendations for the initiation of antimicrobials and fluid challenge. METHODS: This was a 6-month retrospective analysis conducted to determine the impact of an intervention on time to antimicrobials and fluid administration in patients with severe sepsis and septic shock. Patients presenting to the ED who received a diagnosis of severe sepsis or septic shock and were administered 2 antibiotics were eligible for inclusion. The primary outcome assessed was compliance with SSC recommendations for antibiotic and fluid goals within 3 hours of ED arrival. RESULTS: A total of 160 patients were included. In the intervention group, 63.8% of patients met the primary outcome compared with 22.5% in the historical group (odds ratio = 2.32; 95% CI = 1.67-3.23). Time to administration of antibiotics was less with the combination antibiotic bag (CAB: median (IQR) = 72 (48-115) minutes; non-CAB: median (IQR) = 135 (102-244) minutes; P ≤ 0.001). CONCLUSION: This intervention significantly increased the proportion of patients provided with SSC goals of care. Such interventions have not been reported previously and could be meaningful in the management of severe sepsis and septic shock.

Acute Effects of Elastic Bands on Kinetic Characteristics During the Deadlift at Moderate and Heavy Loads.

Loading a barbell with variable resistance positively alters kinetic characteristics during the back squat and bench press but has never been studied during the deadlift. The purpose of this project was to examine the acute effects of combining elastic bands and free weights during the deadlift at moderate and heavy loads. Twelve trained men (age: 24.08 ± 2.35 years, height: 175.94 ± 5.38 cm, mass: 85.58 ± 12.49 kg, deadlift 1 repetition maximum (RM): 188.64 ± 16.13 kg) completed 2 variable resistance (B1 and B2) and 1 traditional free-weight (NB) condition at both 60 and 85% 1RM on a force plate. B1 had 15% resistance from bands, with the remaining 85% from free weights. B2 had 35% bands and 65% free weights. NB used free weights only. Average resistance was equated for all conditions. Power and velocity generally increased, whereas force decreased with the addition of bands. The amount of band tension (B1 or B2) had little impact on power when lifting at 60% 1RM. However, greater resistance from bands resulted in greater peak and relative power when lifting at 85% 1RM. Adding elastic bands decreased time to peak force (PF), time between PF and peak power (PP), and time between PF and peak velocity (PV) when compared with NB at 60% 1RM (NB > B1 > B2). These differences only reached significance for NB > B2 when lifting at 85% 1RM. These same differences existed for time between PP and PV. Thus, the amount of tension from bands has less impact on interpeak variables at heavier absolute loads. Practitioners should consider using heavy bands when prescribing the deadlift for speed or power, but not maximal force.