Adequate fluid resuscitation and end organ perfusion is best indicated by everything, except:

• A. Adequate urine output
• B. Normal mental status
• C. Normal capillary refill
• D. Present bowel sounds

Answer: (D)

End-organ perfusion is best judged by signs that reflect blood flow to the brain, kidneys, and peripheral tissues. Normal mental status indicates adequate cerebral perfusion, adequate urine output shows kidneys are receiving enough blood to filter and produce urine, and normal capillary refill suggests good peripheral perfusion. Bowel sounds, on the other hand, reflect gastrointestinal motility and are not a reliable measure of current perfusion to organs. They can be present or absent for reasons unrelated to how well tissues are being perfused, so they don’t indicate success of fluid resuscitation. In practice, use mental status, urine output, and capillary refill together, while being mindful of factors that can affect them (temperature, medications, injuries).