Flashcards in Fluid resuscitation Deck (25):
What is the BP for hypotension?
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
What are the consequences of hypotension?
Hypoperfusion of organs
Lactic acid production
What are some consequences of metabolic acidosis?
Decrease myocardial contractility
What are some signs of hypovolaemia?
Dry mucous membranes
Mottling of skin
Poor urine output
What does elevated lactate in the blood suggest?
What should the minimum urine output be?
e.g. 30ml/hr for 60kg patient
What fluid resuscitation increases the risk of anaphylaxis?
What fluids are used to re-hydrate patients?
Give some examples of crystalloids
0.9% sodium chloride
Give an example of a colloid
What is more expensive: crystalloids or colloids?
Name a natural colloid
Is there a risk of anaphylaxis when using albumin?
Yes but v small
What is the most physiological colloid?
What colloid also increases the oxygen carrying capacity of a patient?
How should fluids be given initially in sepsis?
500-1000ml crystalloid stat
Repeat fluid as needed
What should never be used as resuscitation fluid?
How much fluid do patients generally need to restore euvolaemia?
Better to give too much than not enough
What is used to monitor response to fluids?
BP, HR and urine output
Repeat lactate may be useful
If the patient does not respond to repeated fluids, what do they have?
Name some vasoconstrictors
Noradrenaline - a agonist
Adrenaline - mixed a/b agonist
What do vasconstrictors do?
Vasoconstrict and increase myocardial contractility
When are vasconstrictors indicated?
Persistent hypotension despite optimised fluid resuscitation