Ann,

important question. I am just an observer of sepsis care, but this always seems 
to be a discussion with uncertain resolution.  often leading to delays in 
therapy.

ultrasound assessment of filling and contraction - diastolic and systolic 
function, would likely help decide when to give fluid to CHF patients as well 
as those with other co-morbidities or even most septic patients after 
substantial fluid.  When should drugs be administered and when should fluid be 
continued. etc.

Can echo be performed by an attending ICU doc, resident, nurse or does this 
require a cardiology consult?

g


George C Kramer, PhD
Director, Resuscitation Research Lab
Professor, Dept. of Anesthesiology
301 University Blvd.
UTMB, Galveston, TX 77555-1102

Office (Mary)           409-747-0077
Direct:                   409-772-3969
Cell:                           409-939-3040    
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Fax:                            409-772-8895
email: [email protected]
http://www.utmb.edu/rrl/

On Aug 17, 2012, at 12:13 PM, Mulligan, Ann W. wrote:

> Our hospital continues to struggle with meeting the fluid bolus requirements 
> when a CHF patient with a low EF presents with sepsis.  Cardiology is 
> suggesting that ED perform a bedside ECHO if the patient has CHF and/or know 
> reduced ejection fraction, and to be prudent when giving several liters of 
> fluid.
>  
> How are other hospitals approaching these patients, and what is the latest 
> guidelines for sepsis treatment within this diagnosis?
> Ann Mulligan, RN, BSN, CPHQ 
> Manager Quality & Outcomes 
> Alta Bates Summit Medical Center 
> 2450 Ashby Ave.
> Berkeley, CA  94705
> Ph: (510) 204-2986
> Fax: (510) 204-1221
> Cell: (510) 325-4044 
> [email protected]
> 
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