Fluids Flashcards
what are the features for SIRS?
Temperature- >38 or 90
WCC > 12 or 20 or PaCO2 > 32
more than one criteria required
what is the criteria for Severe sepsis?
it is SIRS plus 1 organ failure
can range from CVS (hypotension) to renal (low U/o) to hepatic (acute bili elevation)
how does pulse pressure variation give us information about “fluid responsiveness” of a patient?
are their any requirements?
it is a test for VENTILATED patients.
this is also the “swing” that ICU might talk about.
When someone is ventilated, we cause inspiration by forcing air into the lungs. This leads to increased transpulmonary pressures. This leads to INCREASED RV afterload and INCREASED LV preload
There is also increased pleural pressure from mech ventilation leading to decreased RV preload and decreased LV afterload (don’t really understand the dec. LV afterload)
anyway, this leads to increased LV stroke volume, and increased pulse pressure with inspiration
By the same token, the RV stroke volume is decreased, which has a flow on effect to decreased LV preload a few heartbeats later. That leads to decreased LV stroke volume and decreased pulse pressure
the theory goes, that a high variation between these two readings, suggests hypovolaemia
how do you determine if pulmonary oedema is cardiogenic, or non-cardiogenic?
what is the test
which chamber of the heart/region of vessels is the way to find this out?
pulmonary artery catheter - looking at the wedge pressure
this gives us an idea of the left atrial pressure.
If the pulm oedema is cardiogenic, then the LA pressure should be elevated.
the easiest way to measure this is the left ventricular end diastolic pressure
public access to defibs has changed public arrest outcomes
what is the percentage of survival to hospital and then 1 year survival IF the defib is attached, and VF is confirmed
> 25% hospital admission
> 25% survival at one year
what are the indications for cooling with an arrest?
there is evidence of varying strength to suggest that patients should receive 12 - 24 hours of therapeutic cooling following an OOH VF arrest
