Fluid resuscitation Flashcards Preview

Year 2 Sepsis > Fluid resuscitation > Flashcards

Flashcards in Fluid resuscitation Deck (25):
1

What is the BP for hypotension?

90/60 mmHg

2

What causes endothelial dysfunction/capillary leak in sepsis?

Bacteria produce toxins
Toxins stimulate immune system to produce cytokines (TNFa)
Increase nitric oxide production in smooth muscle
Causes vasodilation, capillary leak and decreased intravascular volume

3

What are the consequences of hypotension?

Hypoperfusion of organs
Hypoxia
Anaerobic metabolism
Lactic acid production
Metabolic acidosis

4

What are some consequences of metabolic acidosis?

Exacerbates vasodilatation
Decrease myocardial contractility

5

What are some signs of hypovolaemia?

Cool peripheries
Clammy
Dry mucous membranes
Decreased JVP
Tachycardia
Hypotension
Skin turgor
Mottling of skin
Poor urine output

6

What does elevated lactate in the blood suggest?

Tissue hypoperfusion/hypoxia

7

What should the minimum urine output be?

0.5ml/kg/hr

e.g. 30ml/hr for 60kg patient

8

What fluid resuscitation increases the risk of anaphylaxis?

Colloids

9

What fluids are used to re-hydrate patients?

Crystalloids

10

Give some examples of crystalloids

0.9% sodium chloride
Hartmanns solution

11

Give an example of a colloid

Gelofusin

12

What is more expensive: crystalloids or colloids?

Colloids

13

Name a natural colloid

Albumin

14

Is there a risk of anaphylaxis when using albumin?

Yes but v small

15

What is the most physiological colloid?

Blood

16

What colloid also increases the oxygen carrying capacity of a patient?

Blood

17

How should fluids be given initially in sepsis?

Fluid challenge

500-1000ml crystalloid stat

Then reassess

Repeat fluid as needed

18

What should never be used as resuscitation fluid?

5% dextrose

19

How much fluid do patients generally need to restore euvolaemia?

2litres

Better to give too much than not enough

20

What is used to monitor response to fluids?

BP, HR and urine output

Repeat lactate may be useful

21

If the patient does not respond to repeated fluids, what do they have?

Septic shock

22

Name some vasoconstrictors

Noradrenaline - a agonist
Adrenaline - mixed a/b agonist

23

What do vasconstrictors do?

Vasoconstrict and increase myocardial contractility

24

When are vasconstrictors indicated?

Persistent hypotension despite optimised fluid resuscitation

25

How are inotropes/vasconstrictors administered?

Central venous catheter