Ron, I agree with you that many bedside CC clinicians are not trained well enough to do sequential IVC monitring by ultrasound. I also, unfortunately, do not see the majority of nurse or physicians evaluate jugular filling during fluid resuscitation.
Recognizing at-risk patients or under-resuscitated patients, while following their response to resuscitation is, first and foremost base on non-laboratory beside observations i.e. HR, BP, RR, Temp<36, LOC, Cap refill. The latter showed that over 2/3 of patients admitted to CC with prolonged cap refill went on to worsening organ function with less than 1/3 progressing to worsening organ function with normal cap refill . When was the last time you saw a clinician check cap refill when his or her patient was oliguric or hypotensive? You may do it California Pacific Medical Center and my experience suggest it could and should be done much more than it is. Monitoring IVC, CVP SvO2/CO and LA are all useful adjuncts but cannot compete with a thoughtful observant clinician. Frank Frank Sebat, MD, FCCP, FCCM Medical Director of Rapid Response System And Clinical Methodologies Kaweah Delta Health Care District Hospital Visalia, CA 559 799 9171 -----Original Message----- From: Ron Elkin <[email protected]> To: Dr.Sunil T Pandya <[email protected]> Cc: Sepsisgroups <[email protected]> Sent: Mon, Sep 3, 2012 2:17 pm Subject: Re: [Sepsis Groups] (no subject) In many places, serial IVC ultrasounds by well trained clinicians for the purpose of monitoring resuscitation are impractical if not impossible. It would be a relatively simpler matter to resurrect basic bedside examination skills with serial estimations of CVP based upon neck vein assessments. This has served us well until a central line is placed. Ron Elkin, MD California Pacific Medical Center San Francisco, CA 94115 On Mon, Aug 27, 2012 at 6:40 PM, Dr.Sunil T Pandya <[email protected]> wrote: Dear Dr.Ibrahim, IVC - US dimensions with respirations does give a fair bit of idea of volume status in the ER. Yes, one need to get trained and develop the skills of handling USG. Specificity increases if IVC-US is clubbed with 2D Echo - assessing LV / RV contractility! Sunil ------------ Dr.Sunil T Pandya Hon. Secretary, Association of Obstetric Anaesthesiologists, India (www.aoaindia.com) Hon. Secretary, Society of Obstetric Medicine, India Head, Dept. of Anaesthesia, Pain and Critical Care, Fernandez Hospital (Health care for Women and the Newborn), www.fernandezhospital.com Director, Prerna Anaesthesia and Critical Care Services Pvt Ltd (www.prernaanaesthesia.com) Hyderabad, India. On Sat, Aug 25, 2012 at 8:10 PM, Mohamed Ibrahim <[email protected]> wrote: Dear Friends, does looking at the ivc diameter for patients presenting to the ED with sepsis give a picture of the volume status ? i hope most of the EDs would have an Ultrasound machine. Dr Mohamed Ibrahim M.D,FAAEM Madurai- India Sent from my iPhone _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ epsisgroups mailing list [email protected] ttp://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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