An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
Today, we're going to be reviewing what some might consider to be a landmark study: the CLOVERS trial. The first thing most clinicians do when a patient is hypotensive is provide IV fluids. The surviving sepsis guidelines recommend 30cc/kg in patients who are in septic shock. It often bears reminding that the objective of providing …
Continue reading More Fluids vs. Vasopressors in the First 24h of Septic Shock (CLOVERS Trial)
The blood pressure is low, give a bolus of fluids. Many times that leads to a "nurse dose" as many of us joke about. But are we causing harm? I keep reiterating that fluid responsiveness is when you achieve an increase in cardiac index/output or an increase in stroke volume due to that fluid or …
Continue reading IV Fluid Overload: Don’t Drown your Patients!
This is a question that is often asked. Do we give fluids until the patient no longer "responds to fluids" or start vasopressors early? Should we start early vasopressors in septic shock or wait until fluids resuscitation is complete?Here's my bias: I dislike arbitrarily pounding patients with fluids. It causes harm. We know this. I …
More than 50% of residents do not know how much sodium is in 0.9% NaCl. I know you do, though... it's 154mmol/L. Far more than our "normal" of 140mmol/L. You should know your IV fluid contents. Why do I nag so much with intravenous fluids and their contents? Truth be told, I did not know …
A little history lesson, my friends, regarding the origins of us calling 0.9% saline solution, aka 0.9% sodium chloride, "normal saline". We are all disappointed in ourselves. You've been calling it normal saline, I've been calling it normal saline, we just can't stop ourselves! Of course you know I am referring to 0.9% sodium chloride …
Continue reading Normal Saline: A History Lesson for the Inappropriate Name