Clinical Hot Topics: The Paradoxical Pulse of Sepsis - An Early Clinical Clue to the Presence of Sep

Posted on Thu, Sep 11, 2014

Hosted by Al Sacchetti, MD, FACEP as moderator, Don’t Blink or You Will Miss It - Clinical Hot Topics can feel much like the “speed dating” of training presentations. The 12 hyper-paced presentations covered a wealth of information for the 2014 EmCare Leadership Conference attendees.  Each week, we’ll publish highlights from select clinical hot topics presented at the conference.
In honor of National Sepsis Month, the first clinical hot topic summary is from Michael Pauszek's presentation, "The Paradoxical Pulse of Sepsis - An Early Clinical Clue to the Presence of Sepsis."

Written by Kim Mills

hot-topics-icon.pngWhile teaching medical and mid-level students, the team observed that a paradoxical pulse was present in several patients with clinical sepsis, Systemic Inflammatory Response Syndrome or SIRS.

Could this simple finding, so readily available and free, be an early marker for sepsis? Is it a test that could be done in a few seconds, at triage or even by EMS?

The Study

During a four-month period, all patients at least eighteen years of age or older who met the SIRS criteria were included in the study. As their blood pressure was measured, they were checked for a paradoxical pulse.


  • 105 patients met SIRS criteria
  • 48 of the 105 were ultimately diagnosed with sepsis and 39 of those 48 (or 81 percent) had a paradoxical pulse
  • Specificity for SIRS criteria was 46 percent
  • Only 17 (or 34 percent) of the patients presenting with sepsis had an elevated serum lactate
  • Of the 57 non-infected patients meeting SIRS criteria, 6 were found to have a paradoxical pulse
  • 5 of the 6 presented with bronchospasm and were diagnosed with acute exacerbation of COPD, the other patient presented in anaphylactic shock from amoxicillin
  • 11 (or 23 percent) of the non-infected patients had an elevated serum lactate

The findings suggest that Sepsis should join Bronchospasm and Pericardial Tamponade as recognized causes of a paradoxical pulse.


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