Prehospital Lactate Meters

[NYMedic828]

I'd rather my ambulance had a thermometer before a lactate meter.

A lactate meter is just something I would have to do more work to inspect every tour and keep equipment for.

It won't change my treatment of giving fluids if the patient needs it so why bother when the hospital is 5 minutes away.

I would think establishinga second IV would be more beneficial to saving time than a lactate check.

 

[Melclin]

Ok. So we all know that multiple things can cause an increase in lactate ranging from intense exercise all the way up to septic shock.

My question is why is it unreasonable for paramedics to be able to check a lactate level and use it, along with other clinical findings to help rule in/out sepsis and base their treatment off of it? I'm not advocating basing a treatment path off of a single number from a field lactate test. If we can get a POC lactate level prior to prehospital fluid administration, which will lower lactate levels, why not allow it? I know the hospital is going to do their own labs but would it not help the ER if we come in with a patient with suspected sepsis if we can pass on a lactate level prior to prehospital fluid administration? I'm not saying a "Sepsis Alert" is necessary but would us being able to pass on a lab value during our patient handoff that will help the hospital initiate early goal directed therapy and potentially life-saving interventions be a bad thing? Medicine is a team effort involving multiple specialties, including EMS. It's been stated multiple times in this thread: early fluid resuscitation and antibiotic administration reduce the mortality in septic patients, more specifically patients in septic shock.

We all know that prehospital medicine is not definitive care but isn't that part of our goal? To get the patient the definitive care and early goal directed directed therapy that they need? Does us being able to provide a lab value included in confirming a sepsis diagnosis not help that process? Maybe I'm totally off base here.

I'll agree that EMS education in the U.S. is severely lacking, there's no question about that but a lactate measurement is no more invasive than a CBG measurement. I'm not saying it's going to change our treatment prehospitally, what I am saying is it can/will aid the hospital in initiating early goal directed therapy while they wait for their own lab results to come back.

With all of the above said, the system I work in does not utilize prehospital lactate meters and we do not call sepsis alerts.

Because instituting a (NEW TOY) like this is more complex than simply allowing it. Money has to be found in the budget for equipment, initial education, ongoing education, reprinting protocols, oversight of that education and of (NEW TOY)'s use. Consideration has to be given of any risk inherent in its introduction. Given the speed of transport apparent in your systems from the scene time thread, I'm surprised you guys have time to put gloves on. One does have to consider the risk of paramedics skipping other, perhaps more essential bits, in favour of (NEW TOY).

I'd rather my ambulance had a thermometer before a lactate meter.

A lactate meter is just something I would have to do more work to inspect every tour and keep equipment for.

It won't change my treatment of giving fluids if the patient needs it so why bother when the hospital is 5 minutes away.

I would think establishinga second IV would be more beneficial to saving time than a lactate check.

I can honestly say that a temp informs or even changes a clinical decision in my practice about once every 2 weeks. I can count on one hand the number of times a monitor has changed anything in 1.5 yrs. I'm glad we have both, but if I had to chose, I'd be hard pressed to get rid of a thermometer. I can't fathom why your bosses would spend ALOT of money on something like NIBP, or big brand/expensive head blocks or whatever and then no give you a thermometer.

 

[NYMedic828]

Yea I realize people make the argument that a thermometer doesn't truly change treatment, but it seems silly that we can't have a tool that is so simple, gives a definitive result and cost less than some of our disposable equipment.

But that's for another thread I guess.

 

[Melclin]

Yea I realize people make the argument that a thermometer doesn't truly change treatment, but it seems silly that we can't have a tool that is so simple, gives a definitive result and cost less than some of our disposable equipment.

But that's for another thread I guess.

Maybe I'm just an idiot but I think it often changes treatment. Perhaps sepsis or infection isn't far off your radar, but I've had a few times where I was sitting there thinking...hmmm welll....hmm... and took a temp and everything was clear.