options...pt with a temp of 103.7

[abckidsmom]

Sorry, I was being facetious in my last post. 10-20mls/kg of crystalloid in a septic patient would barely even touch the sides on it's way through. These patients (particularly septic shock patients) are often getting 40ml, 60ml, 80ml/kg and more of crystalloids as well as colloids and pressors and are still struggling to maintain a CVP of 2mmHg (although there is also debate as to how useful measurement of CVP is in septic patients)

LOL, I was gonna say that sepsis is another word for bottomless pit of fluid.

 

[Sam Adams]

Ok, I can get on board with the benefits of coagulopathy (DIC), decreasing vascular permeability, and creating an environment of bacterial/ septi-stasis. But, when re-warmed and without further treatment aren't we back where we started? And, aren't febrile septic pts at the beginning of the end where as cold septic pts at the end of the end?

 

[Veneficus]

Ok, I can get on board with the benefits of coagulopathy (DIC), decreasing vascular permeability, and creating an environment of bacterial/ septi-stasis. But, when re-warmed and without further treatment aren't we back where we started? And, aren't febrile septic pts at the beginning of the end where as cold septic pts at the end of the end?

Yes, but I think how you get to the end matters.

If you are cold because of an external intervention or cold because your body can no longer regulate temperature they are different animals.

Like I mentioned before, I really don't have much insight into this, as I was reading responses, I thought "could there be a reason chilled fluids would help?"

So I figured I'd throw it out for discussion.

I hope to look a little more into it as well as the mechanisms, but this week I am in my least favorite division of medicine and just too lazy and tired to look anymore stuff up than what I have to right now.

But vacation is coming and I can spend as much time as i like with medicine I enjoy then.

 

[Sam Adams]

Yes, but I think how you get to the end matters.

If you are cold because of an external intervention or cold because your body can no longer regulate temperature they are different animals.

For the sake of further discussion: this pt has a GCS of 3 (which if I remember correctly is baseline), what of a pt, same vitals, same presentation, however with a GCS of say ... 12 of 13 and with a patent airway (no trach)? To induce or not to induce? And how would you go about it?

I'm not overly familiar with TH in SCIs and how it's done (RSI, meds etc.) I'd imagine it's similar. Or not. I don't know. Off to go research....

 

[Veneficus]

For the sake of further discussion: this pt has a GCS of 3 (which if I remember correctly is baseline), what of a pt, same vitals, same presentation, however with a GCS of say ... 12 of 13 and with a patent airway (no trach)? To induce or not to induce? And how would you go about it?

I'm not overly familiar with TH in SCIs and how it's done (RSI, meds etc.) I'd imagine it's similar. Or not. I don't know. Off to go research....

If we assume for the sake of discussion that there actually might be benefit in doing this, which I will be looking into after next week because I am curious about it, I think my decision would be based not on mental status or GCS but whether or not he was responding to the antibiotics. (which looks like "no" to me)

So my SWAG would be to:

Induce coma,

hypothermia him with a slurry and the proper maintenence

pour vanc into him while supporting the rest of his functions and wait for cultures and antibiotic recommendations to come back and see where we are.

Wake him up when we find his IgG topping off and see where we are.

 

[b2dragun]

I appreciate all the replies. I am now going to save my cold saline for the summer and for codes, which lately will be often enough. For the past 3 weeks I have been getting one every other shift and four in a row...looking at 9 codes in 3 weeks.

This is why I don't question my medic on scene. I am just going to keep saline in the cooler, on the warmer, and some just in the truck at "room temp."