Wednesday Wrap-up: 8/15/2012

We had some great senior lectures this morning that touched on a bunch of controversial issues in EM. I wanted to talk more about the concept of fluid responsiveness which has become an increasingly popular topic among the EM sepsis literature, lecture circuit, and blogosphere. Ever since the Rivers article from 2001, we all have been taught to use CVP. But in recent years, CVP has been challenged and now concepts like delta pulse pressure, stroke volume variation, and passive leg raise test have been suggested to replace CVP. Passive leg raise is the only one of those that can be used in a spontaneously breathing patient. The question was raised in conference “How do you perform the passive leg raise test?” Below is a link to a post from a great free online resource: The Emergency Ultrasound Podcast that reviews just this very issue. If you have time, check their other great videos on this topic and others at The Emergency Ultrasound Podcast!

Fluid Responsiveness Video Part 1

Fluid Responsiveness Video Part 2

I would love to hear how other are addressing this issue. Is CVP dead? Have you tried the passive leg raise test? I personally haven’t totally given up on CVP but do realize its limitations. Leave your thoughts on this issue below.

Thanks for reading,