How to Give Crystalloid in Septic Shock

One approach is to give a bolus of say 500 mils or 1000 mils that would cover for insensible losses from fever, from tachypnea or diarrhea. Then after you've given that bolus, then you check for fluid responsiveness. If the IVC is plump with little respiratory variation and if there are be lines on lung pocus, then you don't have to give any more fluids. You can look at the heart too to see if it's hyperdynamic with an empty looking LV, which would suggest the need for more fluids to fill that tank. Many experts are also recommending starting norepinephrine as early as possible for patients with a map less than