Septic Pneumonia

[zzyzx]

Sorry to be bringing back to life this old thread, but I've been so busy with school that I haven't had a chance to read EMT City all semester.

I'm curious about what some of the posters have said about giving fluids to this patient en route to the hospital. Personally, I would not be comfortable doing that. How can we be sure that this is just sepsis? How do we knwo that the fluid is going to stay where we want it--in the blood vessels and not go into the lungs? Also, if we gave a bolus and then re-evaluated the patient, how would we do that when she already has wet lung sounds all over. What do you guys think?

Edited April 16, 2010 by zzyzx

[DartmouthDave]

Hello,

Good question.

I think it is safe to that this lady is dry for several reasons.

Increased work of breathing equals increased insatiable losses. The same can be said for the fever as well. Also, I am sure that this has had poor PO intake.

Physical assessment and history also shows a sinus tachycardia with marginal BP. Plus, no overt signs of failure such as edema or JVD. In addition, if I remember correctly, no previous history of CHF.

So, a 250, 500 or a 1000cc bolous of NS all would be acceptable. Depending upon protocol and transport time.

You are correct about the lungs. It would be hard to tell if you are tipping the patient towards failure. However, an improving BP and a decreasing HR in general will indicate that you are heading in the right direction.

Cheers

[zzyzx]

Yeah, I agree with what you're saying, but I just don't see the need to give the fluids in the ambulance. I think you're thinking about this more from a hospital perspective. The BP is not critical, and in my 15 minute ride to the ER, I'm not going to cure sepsis. If my diagnosis is wrong--not having CXR, labs, and time to scratch my chin and think about it--I could make this patient a whole lot more sick by giving fluids.

Edited April 18, 2010 by zzyzx

[chbare]

Yeah, I agree with what you're saying, but I just don't see the need to give the fluids in the ambulance. I think you're thinking about this more from a hospital perspective. The BP is not critical, and in my 15 minute ride to the ER, I'm not going to cure sepsis. If my diagnosis is wrong--not having CXR, labs, and time to scratch my chin and think about it--I could make this patient a whole lot more sick by giving fluids.

Not sure I follow, why are you so worried about giving fluids to this patient? You can always be judicious with your delivery method; however, nothing about this scenario screams of fluid contraindications.

Take care,

chbare.

Edited April 18, 2010 by chbare