As a fellow I presented a lit review on the use of hypertonic saline in resuscitation in sepsis and some interesting effects on cytokines and cellular adhesion molecules were noted(positive effects). I haven't looked at those data in a while but wanted to throw it out to the group. I was feeling a bit salty.
Sent from Rich's iPhone On Apr 22, 2013, at 7:56 AM, "Thomas Morris" <[email protected]> wrote: > Hi Jeffrey > > Thanks - although the Traumatic Brain Injury paper had patients on only > 10hrly litre bags of NS for 48 hours, which is max. 4.8 litres - not that > much is it? Surely you still have to "fill the gap" before, or at the same > time as, getting someone on pressors? > > I think it's a bit of a clinical evidence "hole" though, and personally I'm > planning to use NS for the first 2 litres, then a bag of 5% dextrose (or > possibly D/saline) for the 3rd litre, then flip a coin for what to give after > that! Ie. crystalloid on one side, gelatin-based on the other! Or blood. > No starch! And bring on the research for adjunctive immate immune system > modulatory therapies. > > Tom Morris > Infectious Disease/GIM Registrar > > > On Sat, 20 Apr 2013 19:43:25 -0400 (EDT) > that <[email protected]> wrote: >> All of this must be taken in context of which bundle you are working in. >> Being an ED nurse, our main focus is in the resuscitation bundle and NSS is >> the fluid of choice. We have, on occasion, given albumin but that seems to >> be practitioner dependent. Plasma and PRBC's are next on the list, >> especially if your HCT is low. If you stick to EGDT and get your patient on >> pressors appropriately and start your broad spectrum antibiotics in a timely >> manner you probably won't have to worry about the hyperchloremic acidosis. >> If not it won't matter because the elevated lactate will get you to organ >> failure and death long before you need to worry about hyperchloremia. >> Just my opinion. Jeffrey R Hanlon RN >> Stamp Out Sepsis >> -----Original Message----- >> From: Katzaman, Alecia <[email protected]> >> To: '[email protected]' >> <[email protected]> >> Sent: Tue, Apr 16, 2013 8:40 am >> Subject: [Sepsis Groups] NSS vs Albumin >> What does everyone do in terms of fluid resuscitation – do you give NSS or >> Albumin? What do you do in the ED? DO you have a limit of NSS that is given >> before Albumin is given, or is provider specific? >> Alecia Katzaman, MSN, RN >> Emergency Department Quality Improvement Coordinator >> P.O. Box 16052 >> Reading, PA 19612-6052 >> [email protected] >> www.readinghealth.org >> PHONE: 484-628-4810 >> Advancing Health. Transforming Lives. >> ----- Email Disclaimer ----- >> This email and any files transmitted with it are confidential and are >> intended for the named recipient(s). If you are not the intended recipient, >> you are hereby notified that you have received this communication in error >> and that any copying, disclosure, dissemination, distribution or review of >> it or its contents is prohibited. If you have received this email in error, >> please notify the sender and immediately delete this email from your system. >> --------------------------------------- >> _______________________________________________ >> 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 _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
