Re: Crystalloid fluids & the Fear of Fluid: I was uncomfortable with the crystalloid fluid administration that lacks a "reason for not administering" option. However, now that I better understand the risk of hypoperfusion in septic shock, I can see the rationale: Single organ failure is more treatable than multiple organ failure and death; dialysis, diuresis, and intubation are better options than continuing a state of hypoperfusion to all organ systems. Physicians and nurses at my facility were advised of the following options: order Lasix with the bolus (similar to our practice in blood administration for CHF patients), order a bipap on standby, make arrangements for emergency dialysis if needed, and be prepared to intubate if required. If the fluid bolus is not given, the patient will suffer multiple organ failure due to hypoperfusion and shock. Further, a patient with a low EF and septic shock has a poor predicted outcome already. We have to stop thinking that the fluids are killing people, and take action while the fluids might still help preserve their organ systems. Regards, Gayle Porter, RN BSN
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