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Flashcards in Fluid Therapy Deck (75)
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1

What questions do you ask before prescribing fluid

What is my patients volume status - ABCDE
Does my patient need IV fluid
How much fluid do they need
What type of fluid do they need
What is cause of deficit / surplus and Rx this! e.g AKI / sepsis

When examining for fluid status
- Are they thirsty / check tongue
- Pulse, BP, CRT, JVP
- Oedema - look peripheral and listen to lungs for peripheral
- Look at U+E

2

What are the signs of hypovolaemia

Nausea
Thirsty
Flat veins
Cool periphery
No sweat
Low or postural BP
High HR
Conc oliguria
Responds to SLR

3

What do people with hypovolaemia need

Resuscitation fluid if low BP
Rehydration fluid
Need to work out cause of fluid loss and stop the leak

4

What are the signs of euvolaemia

Feel well, not thirsty
Filled veins
Warm extremities
Mild sweat
Normal BP and HR
Normal urine

5

What do euvolaemic people need

No fluids unless electrolyte deplete or low BP
Can be in this state as fluids are maintaining

6

What are the signs of hypervolaemia

SOB
Not thirsty
Warm and oedematous
Distended vein
Sweaty
High BP and HR
Dilute urine
Oliguric or polyuric

7

What do hypervolaemic people need

No more fluids
Diuretics possibly if respiratory compromise
Haemofiltration if anuric

8

How do you work out fluid deficit

Catheter
Chest drains
Fluid balance chart
Weight
Vomit bowl / sputum pot / stool chart + stoma
U+E's

9

What are the insensible that cannot be measured

Transepidermal diffusion
Sepsis sweat
Ventilation
Open wound
Burns
Blood loss

10

How much water is lost through transepidermal diffusion

400-800ml per day
NO SOLUTE LOSS

11

What are fluids given for

IV vs oral vs NG
Resuscitation
Routine maintenance
Replacement
Redistribution

12

What type of fluid are there

Dextrose
Crystalloids
Colloids - Plasma expanders
All go into different areas of body

13

When do you give resuscitation fluids

Hypovolaemic shock
Cannot perfuse organs

14

What fluid do you give in hypovolaemic shock

Rapid bolus to increase intravascular space

500ml over 15 minutes CRYSTALLOID with 130 mmol of Na (saline)
- 0.9% saline = hypercholaraemic acidosis risk
- Hartman's / PlasmaLyte but caution if hyperkalaemia
Can give further bolus up to 2000ml then senior

Colloid only if haemorrhagic or blood on BTS chart

250ml if HF/ renal / elderly as less strain

15

How do you check that resuscitation fluids have worked

REASSESS
Check BP
Give another 250-500ml if respond
May require vasopressors if in shock

16

When do you give routine maintenance fluids

Fasted patients >8 hours or after surgery

17

What type of fluid is given as routine maintenance

Crystalloid
Look in guidelines to find out what is needed
If >3 days then enteral feeding is preferred

18

When do you give replacement fluids

To replace electrolytes that have been lost - Mg, K, Po4

19

How do you check that replacement fluids have worked

Take blood
Check electrolytes

20

What is dextrose useful in

Chronic dehydration

21

What is dextrose not useful in

Resuscitation
Low albumin

22

Why is dextrose not useful as resuscitation

Isotonic so moves through all compartments and won't expand blood to fill up BP

23

What are most fluids

Crystalloids

24

What are crystalloids useful in

Dehydration
AKI
Sepsis
SHock
Resuscitation

25

What are cryalloids not useful for

Long term maintenance as puts strain on the heart
Hypernatraemia as contains Na
Hyperchloraemic metabolic acidosis

26

How do crystalloids work

Come in various combinations and remain in ECF

27

What is a common crystalloid

0.9% saline
Contains a lot of sodium - risk of hyperchloraemic metabolic acidosis
Plasma Lyte - preferred now post-op as more balanced

28

What are plasma expanders

Colloids

29

What are examples of colloid

Blood
TPN
IV albumin - used in Burns

30

What do colloids do

Stay exclusively in IVS so give if bleeding