Pressors and Fluids - Not either/or but both/and
It's a typical day in the ED. You are asked to see your next patient who is a 60 year old male, recently discharged from the hospital after being treated for cellulitis presenting with abdominal pain and diarrhea. He’s tachycardic and hypotensive to 75/40. The patient is mentating well. After taking a more thorough history your differential diagnosis narrows in on intra-abdominal sepsis associated with significant volume losses. The lactate returns at 6. On volume assessment by physical exam and POCUS, the patient is significantly volume down. You know that getting the antibiotics and fluids on board is the cornerstone of treatment, but they will take some time to be given. You wonder if you should temporize your resuscitation with pressors during the time it takes for the fluids and antibiotics to be administered.