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Apr 1, 2018

Why is “prime the pump”, dying?

 

It’s now accepted that sepsis has more to do with vasodilation, and less to do with vascular permeability. Administering a vasopressor turns unstressed volume into stressed volume and improves venous return.

 

Not every patient will respond to fluid administration with an increase in cardiac output.

 

How much fluid do we give in septic shock, and when do we start a vasopressor?

 

“Just the right amount”, and as soon as it’s evident the patient isn’t or WON’T respond to fluid administration.

 

An interesting, possible way for Prehospital Providers to determine fluid responsiveness:

 

You can test for fluid responsiveness without giving a drop of fluid by using ETCO2 and Passive Leg Raise, but it might not be ready for prime time.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129784/

 

What should be the first line vasopressor for vasodilatory shock?

 

Norepinephrine if you have it, but Epinephrine is fine, and may be preferred in select cases.