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Fluid assessment in sepsis: Elliot Long at DFTB18


Given that DFTB18 was held in Melbourne it was important to highlight the work of PREDICT (the Paediatric Research In Emergency Department International Collaborative)* This talk, by Elliot Long, centred around his work on the role of fluids in the septic child.

Following the recent online discussion around the FiSH pilot study and the potential harms of fluid boluses demonstrated in the FEAST trial, it would seem apropos to release this talk from DFTB18. We seem to have a knee-jerk reaction to giving a fluid bolus in septic children but should we?

The FEAST trial was published in 2011 and has had minimal impact on what we do in the Western setting. However, what we think of a low fluid state – dehydration – is different from what our colleagues in Africa would view as septic. This is something we will explore at a later date.

So if we can’t rely wholly on our history and our physical exam is often equivocal, what other methods are there? Elliot Long likes to use ultrasound to guide his management.

Courtesy of The POCUS Atlas

He then looks at the IVC to see if it is plump or underfilled with the phased array probe.

A plethoric IVC courtesy of The POCUS Atlas

And finally he looks at the heart itself, with the phased array probe, to see if it is hyperdynamic.

Courtesy of The POCUS Atlas

*COI – Both Ben and Andy have done or are doing work under the auspices of PREDICT

This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story‘ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a diagnosis or clinical conundrum at the patient and their families.

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