Jean-Francois Lanctot along with his partner in crime, Maxime Valois, has markedly advanced the field of resuscitative ultrasound. The two of the them also created Echo-Guided Life Support (EGLS) and the Shock Echo app.
Today, Jean-Francois and I discuss the current state of fluid assessment and treatment.
TLDR Take-Home Points
- Rule out obstruction to Venous Return (Can the Right Ventricle Take Volume Loading)
- Look for Left Ventricular Failure (Can the Left Ventricle Take Volume Loading)
- Correct Vascular Tone
- Only then, Decide if the Patient may be Fluid Responsive
Marik and Bellomo on the Fluid Management of Severe Sepsis
See this amazing fluid physiology lecture from the Ultrasound Podcast Site
An Integrated Approach to Ultrasound-Guided Fluid Management
Podcast: Play in new window | Download (Duration: 25:52 — 23.8MB) | Embed
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Editor-in-Chief, EMCrit.org at EDECMO LLC
An ED Intensivist from NY. No conflicts of interest (coi).
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Many times I have seen a patient with undifferentiated shock and PA atheter can be so helpful in these patients. A lot of the sick pts we see have poor windows especially on a vent, or they may have a history of cardiomyopathy and without a PA catheter it can be hard to manage this specific subgroup of pts. An ultrasound has limitations and we cannot estimate pressures with this in all patients! The trials that look at PAC use do not address the pt with severe undifferentiated shock they were excluded. It can definitely be helpful we just need… Read more »
[…] Weingart talks to Jean-Francois Lanctot on EMCrit about Echo Guided Life Support (EGLS) as a way to assess fluid status in septic patients. […]
Scott,
What about the patient with an active head bleed who is also exhibiting septic shock? How aggressive should the fluid resuscitation be?
[…] EMCrit — Podcast 161 – The New Fluid Assessment in Sepsis (2015) […]