Measuring Lactate in the Prehospital Setting - Patient Care - @ JEMS.com

[NYCEMS9115]

This is not FDA approved but seems it will be in the distant future for Paramedics in the U.S. This will be great thing to have in PHC. Consider we in the Private Transports deal with "Septic" patients in the NH. God knows how long they've been hypo-perfusing...

http://www.jems.com/article/patient-care/measuring-lactate-prehospital

[Kiwiology]

About bloody time, this is already happening in Deleware

We have ceftriaxone but no lactate measuring as of yet

[tniuqs]

Dr. Westley is very forward thinking, well for an old hair growing out of his kinda ears guy, but he can drink the occasional rhum too, well so I am told ... lol.

I personally would like to see bedside Troponin CKMB and Myoglobin ... oh wait I already do !

[mobey]

This is such a great idea, I had no idea there were small handheld devices like this on the market.

When dealing with sepsis pt's I usually use urine output to guide my fluid recus, this only works if there is a catheter in place.

[DartmouthDave]

Hello,

Would a lactate level change the treatment a great deal? Would the cost be worth it?

A lactate can be elevated by many things.

Don't get me wrong. I like the gadgets. But, I don't see its utility for a short transport times.

Cheers

[mobey]

Hello,

Would a lactate level change the treatment a great deal? Would the cost be worth it?

A lactate can be elevated by many things.

Don't get me wrong. I like the gadgets. But, I don't see its utility for a short transport times.

Cheers

You are totally right on the short transport times, I keep forgetting to qualify my posts with the fact I do 3+ hr transfers. i do feel however lactate trending could only be beneficial for both the provider and the recieving physician.

Good point on the causes of elevated lactate! Again with the book-learnin stuff. If we are going to put these into practise we must know how to apply them.

[NYCEMS9115]

Were not just talking about short transports; how bout on scene time and enroute times. Also, we tend to negate; how long before the Ambulance was called. In the NH (Most of us know their MO), patient's illness and/or injury has been occurring for a little. So, many of the times the CVA and MI TPA w/in 3 hours is out the window... Of course, not all NHs are like that. However, some are and that's too many...

It will be expensive like any Advancement. Healthcare and Healthcare Cost & Reimbursements are different arguments but Costs and Reimbursements seem to be the reason why some do not move forward...

[chbare]

Other than a JEMS Op-ad is there literature that supports point of care lactate testing by EMS providers? Does this decrease morbidity, mortality, length of stay, days on the ventilator and so on?

Take care,

chbare.

[ERDoc]

I'm with chbare on this one. I'm not sold on the idea, yet. All we know from this study is that high levels of prehospital lactate are associated with a poorer outcome. We already know this from hospital based studies. Let's do some studies to see if we can change outcomes based on prehospital lactate testing. If it will change outcomes, great let's use it. I'm not fully convinced of the utility of lactate to begin with. Early goal directed therapy is great in theory but there are issues with it. The original Rivers study had a physician at the pts beside constantly monitoring the pt. In reality there is no way to do this. A modified form of EGDT is probably a good idea and could be more practical.

As an aside, this discussion demonstrates some of the problems with designing good EMS studies. Look at the differences in transport times we have. This just adds another confounding variable. Something that may be beneficial on a 3 hour transport may be useless on a 15 minutes transport.

[NYCEMS9115]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2040487/