How would you respond to this doctor? - page 2

Caring for a septic lady in her 30's alongside a young-ish new ER doctor. Patient very sick with multi-organ involvement. Just intubated, central-lined, vasopressors, etc. Was given two amps... Read More

  1. by   prep8611
    We all agree that bicarbonate is just a bandaid for this but an additional few amps wouldn't have hurt. Just curious, did he bother hyperventilating the patient or is that just meaningless too? How many liters did the patient receive? Stat antibiotics? what was the lactate? In the icu I work in the patient must be delivered to us within 15 minutes after a central line is placed. It's just unsafe we have a lot more monitoring and intensivists.
  2. by   Esme12
    Doctor: "...No...(waving his hand at the results rather off-handedly) ..this is all metabolic...bicarb wont cure anything..."
    Me....Uhm, since we both agree it's METABOLIC ACIDOSIS it's the bicarb she needs......or we can always discuss this with the attending"
  3. by   Esme12
    Quote from prep8611
    We all agree that bicarbonate is just a bandaid for this but an additional few amps wouldn't have hurt. Just curious, did he bother hyperventilating the patient or is that just meaningless too? How many liters did the patient receive? Stat antibiotics? what was the lactate? In the icu I work in the patient must be delivered to us within 15 minutes after a central line is placed. It's just unsafe we have a lot more monitoring and intensivists.
    That is a great policy.....a majority of ED especially at night.....the ED doc is the go to man.....there are probably more facilities that don't have those resources than those that do.
  4. by   prep8611
    Quote from Esme12
    That is a great policy.....a majority of ED especially at night.....the ED doc is the go to man.....there are probably more facilities that don't have those resources than those that do.
    Ya our intensivists follow the surviving sepsis protocol to a T. We are a community hospital but we still use vigileo monitoring and what not.Im still interested in knowing what the patient's source of sepsis was. Bicarbonate isn't really the answer past a few amps, its only going prevent the patient from coding in the ER which I guess is the goal of the ER. That gas is just not compatible with life. I wish I had more information to know what was going on.... Either way the pt could use a few more amps just for pressor management alone. Septic patients really just dont belong in the ER, too much work for a swamped ER nurse.

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