Intubation: 平常要靠BiPAP, septic shock到用iatrogenic agent，不管ABG如何都可on endo
先charge volume,沒出來才考慮Lasix, albumin
若U/O>1cc/kg/hr, fluid challenge不必急著考慮albumin, FP(not FFP)，光charge volume + Lasix PRN即可
健保albumin之給付：
http://www.nhi.gov.tw/information/bulletin_file/1845_W0960000040-A03.DOCRelative intravascular hypovolemia is typical and may be severe. As an example, early goal-directed therapy required a mean
infusion volume of approximately five liters within the initial six hours of therapy in the trial described above [
17]. As a result, rapid, large volume infusions of intravenous fluids are indicated as initial therapy for severe sepsis or septic shock,
unless there is coexisting clinical or radiographic evidence of heart failure.
Fluid therapy should be administered in well-defined (eg, 500 mL), rapidly infused boluses [
8,9].
Volume status, tissue perfusion, blood pressure, and the presence or absence of pulmonary edema must be assessed before and after each bolus. Intravenous fluid challenges can be repeated
until blood pressure is acceptable, tissue perfusion is acceptable, pulmonary edema ensues, or fluid fails to augment perfusion.
Careful monitoring is essential in this approach because patients with
sepsis typically develop noncardiogenic pulmonary edema (ie, ALI, ARDS). In patients with ALI or ARDS who are hemodynamically resuscitated, a liberal approach to intravenous fluid administration prolongs the duration of mechanical ventilation, compared to a more restrictive approach that typically requires large doses of furosemide [
27]. Thus, while the early,
aggressive fluid therapy is appropriate in severe sepsis and septic shock, fluids may be unhelpful or harmful when the circulation is no longer fluid-responsive. (
See "Supportive care and oxygenation in acute respiratory distress syndrome", section on Fluid management).
shock後會有利尿期，這時的補多出多並不是身體覺得水夠，而是利尿所致，更要補水以免脫水（注意bun/cre, electrolyte）
