In a patient with shock, a fluid bolus is a test, not a destination. Give it, then reassess: blood pressure, heart rate, capillary refill, urine output, lactate trend and work of breathing. Listen for new crackles and check oxygen saturation.
If perfusion has not improved and signs of overload appear, stop and move to the next step, such as a vasopressor, rather than repeating the bolus. Document the response so the next clinician can see what was tried.
- Reassess perfusion and breathing after every bolus.
- Stop fluids if crackles appear or oxygen requirement rises.
- Start vasopressors early if the patient is not responding.
- Record the response to each bolus.
Why it matters
Overload from repeated boluses is avoidable harm.
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