Good morning! Does anyone have any info regarding IV push antibiotics for first dose antibiotic dosing in the ED. We are challanged by some of our payers quality "pay for performance" programs in PA to start and COMPLETE first dose antibiotics within 3 hours of arrival. Our health system has some fairly conservative infusion timing guidelines for nursing - any ideas or resources are appreciated!
William Jenkins, MD Excela Health Emergency Medicine Pennsylvania ________________________________________ From: [email protected] [[email protected]] on behalf of Kramer, George C. [[email protected]] Sent: Thursday, February 13, 2014 9:02 AM To: Daniel Gerard; [email protected] Subject: Re: [Sepsis Groups] LR vs NS for fluid Daniel, I sent this answer out to the group regarding a question on colloid use. A perspective of a physiologist, One to three is the classic crystalloid to colloid ratio and probably good to use for equivalent volume expansion of colloid to crystalloid. But crystalloid expansion is quite transient and colloids are more sustained. This is both good and bad depending on concerns about volume overload. I would say that for clinical use 6% albumin and most starches are similar as to volume expansion. I believe our clinicians use LR first and only go to albumin when LR is not effective and they don't use any fixed rules. Also, I believe they prefer LR over NS due to hypercholremic acidosis with large volume loads. I would say that plasmalyte is best crystalloid, but I don't see that it is used here much. At our institution, in ICU and OR it is almost always albumin as the colloids and ratios of 1/2 or 1/3 are typically used. There is strong evidence about the dangers and limitations of starches due to renal complications. George, George Kramer, PhD Resuscitation Research Lab Dept. of Anesthesiology UTMB, Galveston 409-939-3040 On 2/10/14 5:50 PM, "Daniel Gerard" <[email protected]> wrote: >Im interested in adding LR as an option for fluid resuscitation, both for >the saline availability issue and the problem with hyperchloremic >acidosis from NS. Is there any issue with altering serum lactate levels >when using large amounts of LR for fluid? > >Daniel Gerard RPh >Critical Care Pharmacist >McLaren Northern Michigan >Petoskey, MI 49770 >231-487-4770 >[email protected] > > > > > > >Confidentiality Notice: This e-mail message, including any attachments, >may >contain confidential information. The information is intended only for the >use of the individual(s) or entity named above. If you are not the >intended >recipient, you are notified that any disclosure, copying, distribution, >or the >taking of any action in reliance on the contents of this e-mail >information is >prohibited. If you have received this e-mail in error, please contact the >sender by reply e-mail and destroy all copies of the original message. > >_______________________________________________ >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 Confidentiality Notice: The documents accompanying this email transmittal in addition to the content of the email contain confidential information belonging to the sender. This information is intended only for the use of the individual or entity named above. The authorized recipient of this information is prohibited from disclosing this information to any other party. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or action taken in reliance on the contents of these documents is strictly prohibited. If you have received this email transmittal in error, please notify the sender immediately by reply email and destroy all copies of the original message. _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
