Fluid therapy in the emergency department: an expert practice review
Harris T, Coats TJ, Elwan MH Fluid therapy in the emergency department: an expert practice review Emerg Med J 2018;35:511–515.
Take homes: Not sure anything too new here – read the article, it’s free
- Crystalloid > colloid
- Balanced (Hartmann, PlasmaLyte) may be > unbalanced (0.9% NaCl)
- Don’t assume ED patient same as ICU patient – i.e. don’t apply same guidelines – this goes for patients in Rural NZ!
- Not too much, not too little: guideline driven therapy (e.g. Surviving sepsis) may be detrimental.
- Assessment of fluid status difficult – need some ED / Rural studies
- PO safer than IV
Intravenous fluid therapy is one of the most common therapeutic interventions performed in the ED and is a long-established treatment. The potential benefits of fluid therapy were initially described by Dr W B O’Shaughnessy in 1831 and first administered to an elderly woman with cholera by Dr Thomas Latta in 1832, with a marked initial clinical response. However, it was not until the end of the 19th century that medicine had gained understanding of infection risk that practice became safer and that the practice gained acceptance. The majority of fluid research has been performed on patients with critical illness, most commonly sepsis as this accounts for around two-thirds of shocked patients treated in the ED. However, there are few data to guide clinicians on fluid therapy choices in the non-critically unwell, by far our largest patient group. In this paper, we will discuss the best evidence and controversies for fluid therapy in medically ill patients.