敗血性休克使用輸液急救的指引，很好用，一目瞭然。
PS：除了文謅謅的論文寫作之外，這種圖表式的流程圖最能表達理念及作法指引。
任何一篇實務性的長篇大論，若是無法以這種流程圖(Algorithm)來表達作者理念，就是有兩種原因，第一，作者本身還沒完全搞清楚他在寫些什麼；第二，就是這篇文章跟本沒有健全結構，無法呈現Algorithmm。
PS again, 有時候學生學習不佳，考試成績差，實務應用差，授課老師也是有責任的。
A users’ guide to the 2016 Surviving Sepsis Guidelines
Two aspects of the guidelines should be understood. We illuminate these two aspects through an analysis of the priority currently assigned to early identification and initial treatment of sepsis, including antibiotics and fluid therapy.
First, the recommendation for antibiotic administration within an hour of diagnosis of sepsis is a lofty goal of care, judged to be ideal for the patient but not yet standard care. Despite the best intentions of the healthcare team, antibiotic administration within 1 h from time of diagnosis may be difficult due to the complexity of the hospital environment and essential care being delivered to other patients during the same time period by the same healthcare practitioners and health system. This is one among several “aspirational recommendations” considered by the experts to represent best practice that individual practitioners and healthcare teams should strive to operationalize.
Second, the clinician may push back from use of recommendations for fear that evidence-based guidelines lead to “cookie cutter” medicine and reflexive behaviors that deemphasize the “art” of medicine. The recommendations are intended for a “typical” septic patient. Patients still benefit from the art of medicine, which includes interpretation of data and individualization of treatment. The recommendations provide much-needed general treatment guidance to the bedside decision maker who is busy, pressured to see more patients in less time, and who will use a distillation of the current literature into a coherent set of recommendations suitable for the large majority of septic patients who are “typical”. For most of us in the trenches of everyday care, the lists of specific recommendations (seen in the tables in the manuscript) are a welcome adjunct to personalizing care.
This guidance includes sepsis management in the emergency department, the general hospital floors, and the ICU. For example, the recommendation for an initial 30 mL/kg crystalloid infusion for tissue hypoperfusion is chosen as a one value fit for bedside guidance. Administering 30 mL/kg crystalloid is a useful initial therapy for the majority of patients and this literature supported fluid dose is linked to good outcomes [3, 4]. Figure 2 offers guidance for initial fluid resuscitation and is built forward from the guidelines recommendation for 30 mL/kg initial crystalloid fluid administration within the first six hours for sepsis-induced tissue hypoperfusion. The flow diagram incorporates some of our own opinions for successful fluid resuscitation based on experience and our understanding of the literature.
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