118 Delayed Emergency Department Fluid Resuscitation May Lead to Increased Mortality in Sepsis: A Call for an Optimal Fluid Resuscitation Interval

2020 ◽  
Vol 76 (4) ◽  
pp. S46-S47
Author(s):  
V.J. De Maio ◽  
E.N. James ◽  
M. Piehl
Keyword(s):  
Emergency Department ◽  
Fluid Resuscitation

Use of Physician-Estimated and Patient Self-Reported Weights to Guide Initial Fluid Resuscitation in Emergency Department Patients With Suspected Sepsis

2020 ◽  
pp. 088506662091790
Author(s):  
Jeremy K. Lessing ◽  
William J. H. Ford ◽  
Peter A. Steel ◽  
Sunday Clark ◽  
Rahul Sharma ◽  
...  
Keyword(s):  
Emergency Department ◽  
Fluid Resuscitation ◽  
Fluid Therapy ◽  
Intravenous Fluid ◽  
Medical Providers ◽  
Suspected Sepsis ◽  
Intravenous Fluid Therapy ◽  
Multiple Levels ◽  
Emergency Department Patients ◽  
Elevated Lactate

Background: Knowledge of patient weight is required to guide initial intravenous fluid therapy for patients with sepsis-associated hypotension or elevated lactate. Previous studies have shown patients are better estimators of their weight than medical providers are; critically ill patients, however, may be unable to provide this information. Objectives: This study compares the accuracy of physician-estimated and patient self-reported weights to subsequent inpatient bed/stretcher scale weights for guiding initial protocol-based intravenous fluid therapy in the treatment of emergency department patients with suspected sepsis. Methods: Adult patients presenting with a suspected diagnosis of severe sepsis to a large, urban, academic emergency department had either physician-estimated or patient self-reported weights recorded on presentation. All patients had subsequent inpatient bed/stretcher scale weights recorded on the first day of hospitalization. Results: Physician-estimated and patient self-reported weights linearly correlated ( P < .001) with inpatient bed/stretcher scale weights. Median accuracy error for physicians (5.4% [2.0-10.1]) and patients (3.9% [1.6-6.4]) was not significantly different ( P = .28). Physician-estimated and patient self-reported weights accuracy was determined at multiple levels: within 5% (46%, 57%, respectively), 10% (75%, 90%), 15% (90%, 95%), and 20% (100%, 95%) error tolerances, as well accurate estimates within 5 kg (69.2%, 70.0%). Conclusions: Both physician-estimated and patient self-reported weights are reliable when calculating initial protocol-based intravenous fluid resuscitation for emergency department patients with sepsis.

scholarly journals Optimising fast track care for proximal femoral fracture patients using modified early warning score

2012 ◽  
Vol 94 (4) ◽  
pp. 267-271 ◽  
Author(s):  
B Ollivere ◽  
K Rollins ◽  
R Brankin ◽  
M Wood ◽  
TJ Brammar ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Care ◽  
Fluid Resuscitation ◽  
Early Warning ◽  
Femoral Fracture ◽  
Fast Track ◽  
Care Pathway ◽  
Proximal Femoral Fracture ◽  
Early Warning Score ◽  
Initial Care

INTRODUCTION The care for patients with a proximal femoral fracture has been dramatically overhauled with the introduction of ‘fast track’ protocols and the British Orthopaedic Association guidance in 2007. Fast track pathways focus on streamlining patient flow through the emergency department where the guidance addresses standards of care. We prospectively examined the impact these protocols have on patient care and propose an alternative ‘streamed care’ pathway to provide improved medical care within existing resource constraints. METHODS Data surrounding the treatment of 156 consecutive patients managed at 4 centres were collated prospectively. Management of patients with a traditional fast track protocol allowed 17% of patients to leave the emergency department with undiagnosed serious medical pathology and 32% with suboptimal fluid resuscitation. A streamed care pathway based on the modified early warning score was developed and employed for 48 further patients as an alternative to the traditional fast track system. RESULTS The streamed care pathway improved initial care significantly by treating patients according to their physiological parameters on admission. Targeted medical reviews on admission instead of the following day reduced the rates of undiagnosed medical pathology to 2% (p=0.0068) and inadequate fluid resuscitation to 11% (p<0.0001). CONCLUSIONS Implementation of a streamed care pathway can allow protocol driven improvement to initial care for patients with a proximal femoral fracture and results in improved access to initial specialist medical care.

Monitoring the circulatory responses of shocked patients during fluid resuscitation in the emergency department

2000 ◽  
Vol 26 (2) ◽  
pp. 173-179 ◽  
Author(s):  
P. M. Dark ◽  
H. H. Delooz ◽  
V. Hillier ◽  
J. Hanson ◽  
R. A. Little
Keyword(s):  
Emergency Department ◽  
Fluid Resuscitation

Comparison of Emergency Resuscitation with Colloids and Crystalloids

1985 ◽  
Vol 1 (S1) ◽  
pp. 10-17
Author(s):  
William C. Shoemaker
Keyword(s):  
Emergency Department ◽  
Time Delay ◽  
Fluid Resuscitation ◽  
Clinical Management ◽  
Fluid Management ◽  
State Of Health ◽  
Direct Effects ◽  
Management Protocol ◽  
Fluid Losses ◽  
Prior State

Clinical management is exceedingly difficult to evaluate in emergency patients because resuscitation is often chaotic, disorderly, and frantic. Resuscitation depends upon many factors: the primary illness or injury, the amount of blood and fluid losses, the patient's age, the prior state of health, the associated medical conditions, the time delay in instituting therapy, the volume and rate of fluids administered, and, finally, the choice of fluids given. Although it is difficult to control the effects of these complex interrelated factors, their influence may be evaluated by stratifying patients and then comparing the direct effects and outcome measures within each stratum.There has been persistent controversy over the relative merits of crystalloids and colloids in fluid resuscitation. We studied reviews of fluid management of all hypotensive patients seen in the adult surgical section of the Emergency Department (ED) during a 2½ year period, to compare the conventional crystalloid resuscitation which had been standard for this busy university-run county hospital with a fluid management protocol consisting of about 1/4 A colloids depending on age, cardiac history, and CVP.

scholarly journals Early Resuscitation in Paediatric Sepsis Using Inotropes – A Randomised Controlled Pilot Study in the Emergency Department (RESPOND ED): Study Protocol and Analysis Plan

2021 ◽  
Vol 9 ◽  
Author(s):  
Amanda Harley ◽  
Shane George ◽  
Megan King ◽  
Natalie Phillips ◽  
Gerben Keijzers ◽  
...  
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Clinical Trials ◽  
New Zealand ◽  
Pilot Study ◽  
Fluid Resuscitation ◽  
Study Cohort ◽  
Fluid Bolus ◽  
Randomised Controlled ◽  
Clinical Trials Registry

Introduction: Septic shock in children still carries substantial mortality and morbidity. While resuscitation with 40–60 mL/kg intravenous fluid boluses remains a cornerstone of initial resuscitation, an increasing body of evidence indicates potential for harm related to high volume fluid administration. We hypothesize that a protocol on early use of inotropes in children with septic shock is feasible and will lead to less fluid bolus use compared to standard fluid resuscitation. Here, we describe the protocol of the Early Resuscitation in Paediatric Sepsis Using Inotropes – A Randomised Controlled Pilot Study in the Emergency Department (RESPOND ED).Methods and analysis: The RESPOND ED study is an open label randomised controlled, two arm, multicentre pilot study conducted at four specialised paediatric Emergency Departments. Forty children aged between 28 days and 18 years treated for presumed septic shock will be randomized in a 1:1 ratio to early inotropes vs. standard fluid resuscitation. Early inotrope treatment is defined as the commencement of a continuous intravenous adrenaline infusion after 20 mL/kg fluid bolus resuscitation. Standard fluid resuscitation is defined as delivery of 40 to 60 mL/kg fluid bolus resuscitation prior to commencement of inotropes. In addition to feasibility outcomes, survival free of organ dysfunction censored at 28 days will be assessed as the main clinical outcome. The study cohort will be followed up at 28 days, and at 6 months post enrolment to assess quality of life and functional status. Biobanking nested in the study cohort will be performed to enable ancillary biomarker studies.Ethics and dissemination: The trial has ethical clearance (Children's Health Queensland, Brisbane, HREC/18/QCHQ/49168) and is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12619000828123). Enrolment commenced on July 21st, 2019. The primary manuscript will be submitted for publication in a peer-reviewed journal.Trial Registration: Australian and New Zealand Clinical Trials Registry, ACTRN12619000828123.

scholarly journals Capillary refill time during fluid resuscitation in patients with sepsis-related hyperlactatemia at the emergency department is related to mortality

PLoS ONE ◽  
2017 ◽  
Vol 12 (11) ◽  
pp. e0188548 ◽  
Author(s):  
Barbara Lara ◽  
Luis Enberg ◽  
Marcos Ortega ◽  
Paula Leon ◽  
Cristobal Kripper ◽  
...  
Keyword(s):  
Emergency Department ◽  
Fluid Resuscitation ◽  
Capillary Refill Time ◽  
Capillary Refill

scholarly journals Application Effect of Limited Fluid Resuscitation in Emergency Patients with Multiple Trauma Complicated with Shock

2021 ◽  
Vol 10 (1) ◽  
pp. 7
Author(s):  
Biao Wang ◽  
Jiancheng Qiu ◽  
Wenhao Lin ◽  
Wei Han
Keyword(s):  
Emergency Department ◽  
Multiple Trauma ◽  
Fluid Resuscitation ◽  
The Body ◽  
Control Group ◽  
Therapeutic Effects ◽  
Observation Group ◽  
Coagulation Function ◽  
Complications And Mortality ◽  
Better Than

<p>This article explores the methods and effects of limited fluid resuscitation in the treatment of hemorrhagic shock caused by multiple trauma, which is common in clinic. 80 patients with multiple trauma complicated with shock were randomly selected from the emergency department of our hospital and divided into the observation group and the control group, with 40 members in each group. Patients in the observation group were treated with limited fluid resuscitation, while those in the control group were treated with aggressive fluid resuscitation. By comparing the therapeutic effects of the two groups, it is concluded that the therapeutic effect of the observation group is significantly better than that of the control group. Therefore, adopting limited fluid resuscitation in the clinical treatment of patients with multiple trauma complicated with shock can realize faster recovery, as well as protect patients’ coagulation function, effectively reducing complications and mortality. Moreover, it can also reduce the injury of trauma perfusion to the body, ensuring the recovery of patients.</p>

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