Hi Jeffrey
Thanks - although the Traumatic Brain Injury paper had
patients on only 10hrly litre bags of NS for 48 hours,
which is max. 4.8 litres - not that much is it? Surely
you still have to "fill the gap" before, or at the same
time as, getting someone on pressors?
I think it's a bit of a clinical evidence "hole" though,
and personally I'm planning to use NS for the first 2
litres, then a bag of 5% dextrose (or possibly D/saline)
for the 3rd litre, then flip a coin for what to give after
that! Ie. crystalloid on one side, gelatin-based on the
other! Or blood. No starch! And bring on the research
for adjunctive immate immune system modulatory therapies.
Tom Morris
Infectious Disease/GIM Registrar
On Sat, 20 Apr 2013 19:43:25 -0400 (EDT)
that <[email protected]> wrote:
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
-----Original Message-----
From: Katzaman, Alecia
<[email protected]>
To: '[email protected]'
<[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
P.O. Box 16052
Reading, PA 19612-6052
[email protected]
www.readinghealth.org
PHONE: 484-628-4810
Advancing Health. Transforming Lives.
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