Hello everyone. Thank you all for you questions and answers online. They've been very helpful. My physicians are wondering how to handle those patients who have advanced directives but are not yet comfort care.
* If they are refusing vasopressors, is it correct that they would NOT be included in the measure for septic shock with persistent hypotension? They are refusing one the measure components to give vasopressors. * If they are a DNI (Do Not Intubate), often times the physicians are concerned they could put their patients into CHF if they order the full 30ml/kg fluid bolus without the ability to intubate if required. I've read the prior lively discussions about fluid resuscitation and the lack of data reporting any harm from administering the boluses, but Dr. Townsend also brought up the good point that intubation isn't always an adverse outcome. Any insight with how to manage these patients would be greatly appreciated. Thank you, Brenda Prabhakar RN BSN Sepsis Steering Committee Co-Chair Doylestown Hospital Doylestown, PA
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