EMCrit Wee – The Holy Grail of Fluid Resuscitation is just a Tin Cup

My friend Chad Meyers is an ED Intensivist from NYC. He gave this lecture at ALLNYCEM 2012, but the video sucked. He rerecorded it for the EMCritters.

I will be bringing Roger Harris, MD of SMACC and Sydney ICU fame on the show in the very near future to debate this very issue.

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  1. wow, great lecture ! (as always)

  2. Mats Wistrand says:

    Hallo! This is also a good article that you probably allready have seen.



  3. David Levy says:

    Thanks for some very practical advice to guide luid therapy in ER. most useful!

  4. Steven Moore says:

    Thanks for the clarification on fluid responsive versus fluid tolerant. I agree that although cvp doesn’t represent fluid responsiveness as that is a cardiac output and starling curve dependent process, it is still an important measure for guiding resus in very sick septic patients.

    • Just to be clear, from my perspective, CVP brings nothing to the table over IVC ultrasound. And it doesn’t require a central line. However if you already have a line in, why not add CVP as clinical data.

    • chad meyers says:

      While I agree with Scott that information obtained from IVC evaluation or CVP monitoring is likely interchangeable, the one advantage of CVP monitoring is that it is continuous. I don’t think the advantage merits the placement of central line for the sole purpose of obtaining CVP measurements, but if I have a line in place, I’ll definitely transduce it. It’s just easier to glance at the monitor periodically and order another fluid bolus as opposed to repeating an IVC evaluation intermittently.

  5. Tracy Pepper says:

    Scott and Chad,

    What are your thoughts on the use of continuous ScVO2 monitoring with the Edwards catheter? Our intensivists want us to place them in the ED, and feel they are essential to optimal resuscitation. I agree that the information provided is useful, but the catheters are expensive and would require additional training for our nurses to learn how to calibrate them. Our department is already pretty strapped for new equipment and is staffed by many traveling nurses, making training for a new technology challenging. Is it worth pushing my department on this?


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