Shock and Fluid Resuscitation Flashcards
(25 cards)
do you want to give fluid in an anemic patient?
probably not
do you want to give fluid in a cardiogenic patient?
no: having trouble handling fluids already
how do you give a large amount of fluid quickly?
- IV!
- increase pressure: gravity, pressure bags ie slam bags, rapid delivery system
infusion pumps are not the fast way: fastest they can deliver is 1 L/hr
what are examples of hypotonic fluids?
0.45% NaCl, D5W
what are examples of isotonic fluids?
LRS, plasmalyte A
what are examples of hypertonic fluids?
7-7.5% NaCL
what are examples of colloids?
hetastarch, vetstarch
what type of fluid has the lowest volume expansion power and should thus not be used for resuscitation?
hypotonic fluid!! VEP 8.3%
what is the VEP of isotonic crystalloids?
25%. minimal side effects, but 3/4 of it disappears and gets peed out
what is VEP of colloids?
100%: good!
pricey, and these stay in pt for a long time: if you have something wrong, you are going to be stuck with that fluid for a while
what fluid type has the highest VEP?
hypertonic saline: 7.0-7.5% NaCl
draws fluid from intracelular compartment and interstitium into ECF
what are the shock doses of fluids for dogs?
isotonic: 80-100mL/kg
colloids: 20mL/kg
blood products: 20mL/kg
hypertonic fluid: 5mL/kg
what are the shock doses of fluids for cats?
isotonic: 40-60mL/kg
colloids: 10mL/kg
blood products: 10mL/kg
hypertonic fluid: 3mL/kg
how much of a shock dose should you give?
- aliquot of the shock dose! 1/4-1/3 depending on many many factors”. monitoring, age, comborbidities, speed of loss, etc
ok so now that we know we need to give a partial shock dose, what is a fair start?
- fluid challenge: 5-20mL/kg IV bolus: lower for cats, higher for dogs
10mL/kg bolus is a good start!
usually 5-30 minutes depending on many patient factors
what products are exceptions to the fluid challenge/smaller shock bolus rule?
- hypertonic saline: use the FULL shock dose (ie 3-5mL/kg) given over 5 mins. these redistribute in all compartments in 20-30 mins
- blood products: use higher aliquots of shock dose. can be given fast! if possible equal volume of plasma and RBC
what happens if you give a shock hypertonic saline bolus too fast/slow?
too fast = bradycardia/vasodilation
too slow = lose VEP
hypertonic saline boluses should be followed by
another type of fluid- colloids or isotonic crystalloids, but less volume of those are required. use as volume sparing
in what patients should hypertonic saline NOT be used in?
pediatrics/neonates! cannot handle the Na_
what if your shock dose doesn’t work?
- more fluid?
- positive inotropes like dobutamine?
- vasopressors: dopamine/norepinephrine/vasopressin
when do you allow a patient to be hypotensive permissively?
- hypotensive patient with UNCONTROLLED hemorrhage!!
- keep systolic blood pressure 80-90mmHg until hemorrhage is controlled. don’t want to raise BP bc body is trying to make a clot, and if BP increases, clot pops and just get more hemorrhage
sepsis is a special circumstance regarding fluid usage. what steps do you take in a septic patient to revive them?
- early fluid resuscitation
- early use of vasopressor: ie norepinephrine
- early abx use
- find and control source of sepsis!!
what fluids need to be used in burn patients?
higher volumes of crystalloids: evaporative losses!!
maybe also colloids or albumin products bc of protein loss
when do you use blood products for fluid resuscitation
severe hypovolemic hemorrhagic shock
