Just wanted to know how other units do things. When we have a post op open heart they come back with all kindsa orders to manage them hemodynamically (as probably all open heart patients across the country do). But we technically do not have orders to give volume as we see appropriate. So lets say someone comes to the unit on a little dobutamine to keep the CI greater than 2 and then whatever else to keep your BP where it's supposed to be. If a patients index starts to trend down you can treat it in several ways, increasing preload, afterload reduction, or increasing contractility with inotropes. Most of the time they just need more volume and so we all the doc saying things like "My index is dropping, my urine output is dropping, and my PA and CVP have been steadily decreasing. What in the world do I do??" Doc: "Oh well it sounds like they just need some volume what dont you do this ___." Nurse: "Oh great idea! Wish I would have thought of that." Is this basically how it works at other units or do you have orders to give x amount of fluids based on some parameter? I'm not really saying our way is that bad either but it just seems odd that I can have freedom to increase inotropes and pressors as I see fit but don't have a way to give more volume which is usually going to be a much safer alternative to treat the low cardiac output (or BP or urine output or whatever). How does everyone else do things?