Decision making in fluid therapy Flashcards
(12 cards)
1
Q
What clinical signs are expected in a <5% dehydrated patient?
A
No abnormalities on exam but a history of V+, D+ or other fluid loss assume some dehydration is present.
2
Q
What clinical signs are expected in a 5% dehydrated patient
A
Dry/tacky MM.
3
Q
what clinical signs are seen in a 7% dehydrated patient
A
- dry mm
- increased skin tent
- May see compensated shock (tachycardia with normal PQ, normal BP)
4
Q
What clinical signs are seen at 10% dehydrated
A
- Dry mm
- Increased Skin tent
- Early decompensated shock, tachycardia with a prolonged CRT, reduced puslses and pale mm
5
Q
What clinical signs are seen at 12% dehydrated
A
- Dry mm
- Increased skin tent
- Sunken eyes
- decompensated shock (tachycardia, weak/absent pulses, long CRT, pale mm, cold extremities hypothermia)/
6
Q
what is a normal urine output
A
- > 2ml/kg/hr polyuric
- 1-2ml/kg/hr normal
- <1ml/kg/hr oliguric
- 0ml/kg/hr anuric
7
Q
Hoe can ongoing Gi loses be monitored
A
- use of pre weighed absorbant pads which are weighed and 1g = 1ml.
- use of a fecal foley cath in recumbant patients with very watery D+
8
Q
What bloodwork changes may suggest dehydration
A
- increased PCV/TS (though care in anaemic or hypoproteinaemic patients)
- pre renal azotaemia
- sodium could be low normal or high depending on the compartment of fluid loss
monitor blood gas and lyes at least 1x daily in hosp
9
Q
What is the value in monitoring USG
A
- Dehydrated patients with normal renal should have USG >1.030 and UOP <2ml/kg/hr.
- Isotheuria on a patient recieving fluids usually = hydrated (care early AKI)
10
Q
How was measuring CVP proposed to guide fluid status
less used now see cardio 1
A
- transducer in central venous catheter at the level of the right atrium.
- was used to estimate right atrial pressure thus preload and volume status.
11
Q
What POCUS parameters could be used to monitor IVFT
A
- LAAO, increasing = hypervolaemia
- CVC size and distensibility
- Check for developing B lines
12
Q
A
