Kerry Doolin

Hi Sara,

This is a great question. Sepsis is a form of shock that is often multifactorial – so the underlying mechanism behind the poor cardiac output is a result of vasodilatory shock meaning we need to reach for a vasoconstrictor such as norepinephrine first. However, as the patient if often hypovolaemic, you need to make sure that the patient is adequately fluid-loaded first. Once you achieve these things yet still have hypotension, then managing the poor contractility is what needs to be done.

Using your point of care ultrasound you can measure fractional shortening – this will help you to evaluate left ventricular function which is commonly low in sepsis (we do cover fractional shortening in the shock and cardiac lectures). If the fractional shortening is low OR your patient is adequately fluid-loaded and not responding to norepinephrine, you can presume there is impaired cardiac contractility – then use either dobutamine or pimobendan. Pimobendan is convenient as it is used twice daily as an injection but can be quite expensive. Dobutamine is used as a CRI. Which you use is often due to availability or clinician preference.

The physiology behind cardiac dysfunction in sepsis includes:
– impaired left ventricular function causing poor contractility
– systemic vasodilatation.
– pulmonary hypertension leading to impaired right ventricular performance
– myocyte dysfunction and peripheral vasodilation due to inflammatory mediators (nitric oxide)
– cardiac dysrhythmias

Have a read of the sepsis guidelines for humans – you can see after fluid-loading and norepinephrine, the evidence for recommended drugs is weak.

Hello everyone,

I am really excited to be teaching this course. I have been a specialist for a few years, but have been an emergency vet my entire career of 17 years. I have been lucky enough to develop my career around the world, from starting in Australia to moving (with my cat!) to London, Manchester and Glasgow. Now I am back in Australia and if not writing lectures I am growing my ICU team.

I love being a critical care vet and I really enjoy teaching. So I am really looking forward to this course progressing and being part of your journey through discovering ECC or furthering your understanding. Scott and Andy have been a big part of my career over the last few years and I can’t wait to be part of this course with them.

Kerry 🤓