I think we all recognize the variability in care delivery that is evident in this thread, and we probably agree that it largely results from a lack of definitive evidence for one fluid choice over another. However, because septic shock is a classic multi-professional and multi-dimensional problem that involves the ED and the ICU, it is worth making the point that while the focus may be on specific interventions in one setting, the choices made will have downstream effects in other settings. I make this point because we work best as a team, and using the example below, the hyperchloremic acidosis from normal saline is an after effect that has to be dealt with in the ICU and is associated with worse outcomes. While that may not be evident from the initial intake and ED setting, it is relevant from the institutional perspective, and (much more importantly) it is critical from the patient’s perspective if it requires later intervention or causes subsequent harm.
Greg From: [email protected] [mailto:[email protected]] On Behalf Of that Sent: Saturday, April 20, 2013 7:43 PM To: [email protected]; [email protected] Subject: Re: [Sepsis Groups] NSS vs Albumin All of this must be taken in context of which bundle you are working in. Being an ED nurse, our main focus is in the resuscitation bundle and NSS is the fluid of choice. We have, on occasion, given albumin but that seems to be practitioner dependent. Plasma and PRBC's are next on the list, especially if your HCT is low. If you stick to EGDT and get your patient on pressors appropriately and start your broad spectrum antibiotics in a timely manner you probably won't have to worry about the hyperchloremic acidosis. If not it won't matter because the elevated lactate will get you to organ failure and death long before you need to worry about hyperchloremia. Just my opinion. Jeffrey R Hanlon RN Stamp Out Sepsis [World Sepsis Day Logo]<http://www.world-sepsis-day.org/WSD/en?sid=u5iqdrmsatL1SZb01Ehxkw&iid=2> -----Original Message----- From: Katzaman, Alecia <[email protected]<mailto:[email protected]>> To: '[email protected]' <[email protected]<mailto:[email protected]>> Sent: Tue, Apr 16, 2013 8:40 am Subject: [Sepsis Groups] NSS vs Albumin What does everyone do in terms of fluid resuscitation – do you give NSS or Albumin? What do you do in the ED? DO you have a limit of NSS that is given before Albumin is given, or is provider specific? Alecia Katzaman, MSN, RN Emergency Department Quality Improvement Coordinator [Description: Description: RHLogo_Email] P.O. Box 16052 Reading, PA 19612-6052 [email protected]<mailto:[email protected]> www.readinghealth.org<http://www.readinghealth.org/> PHONE: 484-628-4810 Advancing Health. Transforming Lives. ________________________________ ----- Email Disclaimer ----- This email and any files transmitted with it are confidential and are intended for the named recipient(s). If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any copying, disclosure, dissemination, distribution or review of it or its contents is prohibited. If you have received this email in error, please notify the sender and immediately delete this email from your system. --------------------------------------- _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ________________________________ This e-mail message (including any attachments) is for the sole use of the intended recipient(s) and may contain confidential and privileged information. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this message (including any attachments) is strictly prohibited. If you have received this message in error, please contact the sender by reply e-mail message and destroy all copies of the original message (including attachments).
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