Melclin
Forum Deputy Chief
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This is an issue that I've discussed with a lot of people at work and its hard to get a clear answer. I may have even asked the question here as well.
I'll give you a quick scenario to illustrate my my point.
55YOM, hx well controlled hypertension, "small MI" 3yrs previously with no subsequent issues on echo. Presents to GP with 2/7 productive cough, 1/7 rigors, night sweats, worsening SOB. Called to GP office to take pt hospital. SpO2 86 on RA, RR 32, T 39.8, BP 165/95, HR 111, ++cold extremities. Diminished breath sounds on lower L lung field. He got oxygen, bloods drawn, 2g of ceftriaxone and off to hospital we trot.
Now comes the question of fluid. We're warned to be conservative with fluid admin in septic pts with a resp focus for fear of iatrogenic pulmonary oedema.
My question is how legitimate is this fear? If the pt above had a UTI, I'd be reaching straight for the fluid. But I worry about the pt with a resp focus.
Are you adjusting the rate or dose of fluid in septic pts with respiratory focus? How and why? If not, why not.
I'll give you a quick scenario to illustrate my my point.
55YOM, hx well controlled hypertension, "small MI" 3yrs previously with no subsequent issues on echo. Presents to GP with 2/7 productive cough, 1/7 rigors, night sweats, worsening SOB. Called to GP office to take pt hospital. SpO2 86 on RA, RR 32, T 39.8, BP 165/95, HR 111, ++cold extremities. Diminished breath sounds on lower L lung field. He got oxygen, bloods drawn, 2g of ceftriaxone and off to hospital we trot.
Now comes the question of fluid. We're warned to be conservative with fluid admin in septic pts with a resp focus for fear of iatrogenic pulmonary oedema.
My question is how legitimate is this fear? If the pt above had a UTI, I'd be reaching straight for the fluid. But I worry about the pt with a resp focus.
Are you adjusting the rate or dose of fluid in septic pts with respiratory focus? How and why? If not, why not.