Measure of Resuscitation
What measurement or technology, knowing BP measures aren’t always best, and mental status and peripheral pulses aren’t reliable, would be reasonable to field medics as a measure of resuscitation? Would a cost-efficient field lactate monitor be worthwhile?
Is there a surrogate for lactate that could be used while awaiting an FDA approved, preferably CLIA waived option for the cost-efficient field lactate monitor?
By surrogate for lactate, do you mean another lab value? Like Base Deficit…or do you mean a surrogate Point of care testing device: like iStat or EPOC that approved in US? (see POCT paper)….or do you mean a surrogate non-laboratory measure, like urine output?
I know, I didn’t answer your question. I made up the ones above because I don’t know if we’re shooting at the correct target. I’m waiting for some other guys with more experience to weigh in on the accuracy of current POCT devices that just measure lactate, that are small, and, theoretically, less expensive than currently available devices (above) in the US.
My question to the SME’s is: is lactate “good enough” that we should be focusing on that measure as an accurate surrogate for tissue oxygen debt? Your question, I think, is: is there something good enough in the meantime, currently available you can use today?… assuming lactate measurement is the ultimate goal
Hyperglycemia in a shock state is a poor prognostic indicator (PMID: 24227559). However, I don’t think there’s good literature to show you can take an improvement in the value as a surrogate for improved tissue perfusion.
I’m a FF/PM, so be gentle…
We are looking at lactate monitoring as a part of our routine blood draw: glucose and now lactates for a few reasons. Agitated Delirium and Sepsis.
The devices out there are as simple to use as a glucometer.
This podcast discusses some of the agitated delirium issues:
http://toxtalk.org/archives/66 and why we as pre-hospital providers could use lactate monitoring to warn of impending cardiac irritability…
So i guess it could be used to trend for PFC…
I’ll be sure to listen. I heard the guys in the “Taming the SRU, Penetrating Trauma,” episode say that glucose is the poor man’s lactate and that they would begin giving blood products to a patient with penetrating trauma and a glucose level above 180. Thoughts? I haven’t looked into this yet.
My only thoughts are:
Blood glucose is measured in mg/DL (1liter = 10 deciliter) so in a volume depleted pt are we only confirming a hypovolemic state because the patient is depleted to the point that the “calibration” is skewed? And therefore artificially high? Or are we measuring the body’s inability to move blood because they are depleted and therefore cannot use glucose and therefore a correction could be seen to an anaerobic metabolism?
Not sure if my last comment came through or not but I would be Interested to know if it’s a calibration issue between the glucometer and blood volume getting artificially high blood glucose Reading or is it because blood is not moving therefore the volume depleted and it’s causing decreased metabolism and therefore increasing the blood glucose level because Its not being utilized. Perhaps is a correlation that can be drawn
It’s not like the testing blood glucose on hypovolemic patients when their calibrating the instruments mostly normal blood volume patients
If 1 L equals 10 dL a loss of a 1 L to 1.5 L in a 5-7 L patient would skew the results significantly…