It has been dogmatically believed that prolonged infusion of any vasopressor mandates placement of a central line. However, available evidence doesn’t support this. Diluted solutions of all catecholamines are safe (except Vasopressin) to be administered peripherally via a well functioning 18-20G IV or larger in forearm (no hand/wrist/AC) . No old IVs (>72 hrs) Know how […]
The recommendation for an initial fluid bolus of 30 mL/kg was downgraded from a strong recommendation to a weak recommendation, based on the low quality of evidence. However, resuscitation should start immediately. Balanced crystalloid solution (e.g., lactated Ringer’s solution) should be used (rather than normal saline) for resuscitation. Administration of vasopressors should be initiated via […]
DID YOU KNOW: In managing shock, for every liter of normal saline given, only 180mls remains intravascular (your normal adult intravascular volume is approx. 5L). So in hypovolaemic patients…give loads of fluids…for blood loss, give blood early, the best natural colloid.
The choice of crystalloid fluid for volume resuscitation is debated often. With rising concern about the effect of hyperchloremic metabolic acidosis associated with normal saline, clinicians more commonly are opting for balanced crystalloids, such as lactated Ringer’s solution or Plasma-Lyte.
The first step, before monitors are attached or IVs are even attempted, is to administer epinephrine 0.5mg IM in the lateral thigh. IM epinephrine can be repeated every 3-4 minutes.
A – Quick Sequential Organ Failure Assessment Score (qSOFA) calculator B – Sequential Organ Failure Assessment Score calculator