BP in Sepsis, Abx for COPD, and Fever in SSD

We had our last Journal Club on September 17, and it was great.  Much great discussion.

First Article:
http://www.ncbi.nlm.nih.gov/pubmed/22923662
Efficacy of antibiotic therapy for acute exacerbations of mild to moderate chronic obstructive pulmonary disease.
Bottom Line: Antibiotics may be useful in mild to moderate COPD exacerbations; whereas we already know it's beneficial (mortality benefit) in severe COPD.  Gerenalizability is limited by choice of antibiotics, and infrequent use of steroids.

Second Article:
http://www.ncbi.nlm.nih.gov/pubmed/24635770
High versus low blood-pressure target in patients with septic shock.
Bottom Line: This is a good one that was overshadowed by the Process Trial.  No benefit for MAP goal of 85 vs 65.  However, in patient's with hypertension, the high target group required less renal replacement therapy.  So, you may consider a higher target in those with chronic hypertension, but no strong, compelling evidence to do so.  Also, probably doesn't matter in the ED.

Third Article:
http://www.ncbi.nlm.nih.gov/pubmed/23669523
Bacteremia risk and outpatient management of febrile patients with sickle cell disease.
Bottom Line: In pediatric patients with good follow up, it is safe to discharge a febrile sickle cell patient after a shot of ceftriaxone - less than 1% of these patients had bacteremia.  I think the key here is that this was Boston Children's, and they all had good follow up.  So, if that's your scenario, discharge away (unless they look ill, of course).  Great comment from one of our community docs - "I've never gone home and thought dang, I wish I wouldn't have given that rocephin."