Are we drowning our patients?

I’ve been a bit busy across at sydneyhems.com for a while, but while I’m writing my next little bit, here’s a link to the good people at jems.com who have published something I wrote a while back on fluid resuscitation.  JEMS (Journal of Emergency Medical Services) is an American EMS journal that mainly publishes reviews of topics aimed at paramedics.

It’s a bit of a rant (imagine that) and fairly lighthearted.  More thought provoking and hypothesis generating than practice altering.  But I think that the way we resuscitate people with fluid will change significantly over the next few years. Anyway, have a read and see what you think?

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5 thoughts on “Are we drowning our patients?

  1. Hey, just stumbled onto your blog while catching up on some LITFL Reviews tonight. As luck would have it I actually also happened upon this JEMS article last week and found myself cursing at you through my computer for your comments on fluid resus in septic patients. I’m glad I gave myself some cool-off time before commenting there, because it turns out I really like your writing and you do raise some valid points.

    The real issue is that I’m just not sure if JEMS is the right place to be having a discussion about the future of fluid restricting septic patients. I can barely get most of my prehospital brethren to follow the current standard of care (based on research from 10 or more years ago) and fluid resuscitate these patients, let alone get them to understand that while fluid restriction might have it’s merits someday, they are tenuous at best right now and purely theoretical. From my standpoint you would have been better off not even mentioning the peds malaria study in JEMS just yet, as it rather shocked me to stumble across it there.

    Anyway, I just wanted to say hi, and sorry for almost leaving an angry tirade on your JEMS article :) Keep up the good work, and thanks for putting out some great content!

    • Thanks for your comments Vince. I’m always up for an argument :) I was in 2 minds about the article in JEMS and accept that it may not have been the best forum, but I think they are trying to raise the bar in prehospital care and I think that the FEAST trial is to important for anyone working in emergency care not to know about. I like writing about anything that undermines medical dogma and resuscitating patients with large amounts of fluid is definately dogma. Hypotensive resuscitation in trauma is as proven as it’s ever going to get. I don’t know what the future holds for sepsis but I strongly suspect that it involves a lot less fluid. I do accept however that knowledge of sepsis in general isn’t as high as it should be amongst EMS providers and perhaps we should have reinforced the current standard of care of volume resuscitation before saying that some of the leading minds in intensive care aren’t sure if it helps or harms patients. Thanks again. D.

      • Glad we’re on the same boat. I too think we’re going to be finding a better way of evaluating fluid requirement over the next few years. Our current practice certainly seems to do well for the first 24 hours, but after that the interstitial distribution of the fluids is just insane. While you feel pretty good when you see that your hypotensive septic patient has made it out of the hospital alive, the fact that they’ve gained twenty pounds of fluid weight and leave a trail of weeping edema wherever they go really makes you think there must be a better way…

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