Might be a dumb question but

[elijahvegas]

is ordering fluids in the er just a routine standard of care for docs or something? almost every patient we see docs order a liter of fluid right off the bat, regardless of any vitals that might indicate a need for it.

if an IVP med is ordered, theres a liter of fluid ordered with it.

sometimes pts will ask me why are they receiving fluids, and I end up having to give some vague answer like "in case we may think you're a bit dehydrated" or "it aids in circulating the medication we gave you into your system a bit easier" or if I'm giving a bp med i'll say "just in case you're sensitive to it and your pressure ends up bottoming out" but honestly I have no clue, and I don't get a straight answer when I ask the docs about it

anyone have any insight?

[blondy2061h, MSN, RN]

Pharmacy is sure to time it for 7 am change of shift too!

Manufacturer recommendation of before breakfast

[Guest219794]

The fundamental cornerstone of emergency medicine is tissue perfusion. Without adequate tissue perfusion comes ineffective cell metabolism and without effective cell metabolism the patient dies. So, in a patient with whom you do not know what is wrong quite yet, a liter of fluid is an effective baseline treatment. It's difficult to know what the patient's preload is just by looking at them, and it's hard to know whether their SVR is low (thereby contributing to their inadequate tissue metabolism) so in these cases IVF won't harm them but it very well could help them. IVF can assist in a multitude of possible worst-case scenario differential diagnoses. Septic shock? IVF helps maintain vascular tone. Acute renal failure? IVF can only help kidney perfusion. Myocardial infarction? IVF can restore volume in cardiogenic shock. It has a good risk vs benefit ratio.

This is the case in many emergencies. Other thna heart failure, most people tolerate IVF well, and some benefit from it.

But, that is not what the OP is about, as far as I can tell.

Look at all the non-emergent patients who would be better served by going to their own PCP, or even a walk in clinic. The overwhelming majority of them would be treated without IV access, and certainly with no IV fluids with no problem at all. Yet we grumble about misuse of the ER, then go ahead and validate this misuse by giving stuff that would not be given in the PCP office.

Walk into your doc's office complaining of diarrhea and tolerating po, and what is the treatment?

In the ER, we are going to give IVF, and maybe a set of labs "just to be on the safe side", which is "treatment" none of us would allow on our own families.

[Rocknurse, MSN, APRN, NP]

I disagree with the treat and street mentality. That's pretty much assuming that there's nothing wrong with the patient other than a mild case of an upset stomach. As providers (NPs, PAs, MDs) we're taught to look at the patient collectively and to not miss the "not miss" diagnoses. What if you gave the man complaining of N+V nothing more than zofran and sent him home, but you failed to notice the lactic acid of 12 due to burgeoning ischemic bowel? Or the white cell count in someone with undiagnosed leukemia? Or an as yet undetected volvulus? We can only discover those things by comprehensive testing. Sure, that means some people are over-treated and over-tested, but for those people who we discover have a serious health condition, if they were under-tested and under-treated the families would be the first ones beating down the malpractice lawyers door. It's the nature of the beast.