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Consider BNP, Echocardiogram, ETT

Echocardiogram


Perform echocardiogram or bedside cardiac ultrasound to assess for:

  • Pericardial effusion or cardiac tamponade in fluid-refractory/catecholamine resistant shock

  • Ventricular dysfunction in cold shock

  • Intravascular fluid status in patients with persistent shock

BNP


Consider sending BNP if concern for cardiac dysfunction or cold shock

  • Normal BNP: Reasonably high negative predictive value to rule out cardiac dysfunction in sepsis

  • High BNP: Often seen in sepsis due to inflammation or renal dysfunction, may or may not indicate cardiac dysfunction

ETT


Consider intubation if inotropic unresponsive shock or concern for respiratory distress

 

Retrieved from: http://www.chop.edu/clinical-pathway/severe-sepsisseptic-shock-icu-clinical-pathway-infants-28-days-and-children-9

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.