A.8 Flashcards
how to evaluate fluid status?
- clinical
- echo
- CVP monitoring
- PiCCO
- swan ganz
fluid status evaluation clinical aspect?
- skin turgor
- tongue and mucous mem. dryness
- daily urine output
what do we check in fluid status evaluation during echocardiography?
- IVC diameter
- IVC collapsebility: spon. breathing (indicates fluid responsiviness)
- IVC distensibility: when patient is on ventilator
how do we monitor CVP?
- invasive
- catheter through SVC
- measures pressure rather than volume
PiCCO meaning?
- Pulse index Continous CO
- invasive method uses 2 techniques for advanced hemodynamic and volumetric monitoring
- transpulmonary thermodilution: to monitor PRELOAD
- pulse contour analysis: to measure CO and SV
What is swan-ganz catheter?
- pulmonary artery catheter
- very invasive
- most accurate
what can we monitor with swan-ganz?
- Cardiac pressure
- pulmonary pressure
- mixed venous saturation
- central temp
- continuous CO monitoring
- PWCP (preload)
Isotonic crystalloids?
0.9% saline solution
Lactate ringer
Isolyte
when do we use isotonic crystalloids?
best for IV resuscitation
normal saline (0.9% NaCl) application?
- fluid resuscitation
- maintenance fluid therapy
- hypovolemic hyponatremia
- solvent for IV drugs
risks of using 0.9 Nacl?
- hyperchloremic acidosis
- fluid overload
what is Lactate Ringer’s solution?
Na
Cl
K
Ca
lactate
Lactate ringer’s clinical application?
fluid resuscitation
maintenance fluid therapy
Risks of lactate ringer’s?
- lactate accumulation in liver failure
- contains calcium
- fluid overload
hypotonic crystalloid
Saline solution (0.45% and 0,22%)
Dextrose Solution (5% and 10%)
clinical applications of dextrose solutions?
- correction of free water deficit (Hypernatremia)
- maintenance of fluid therapy
- dextrose is good solvent for IV drugs (NE infusion)
increases EC vol. and IC vol.
risks of dextrose solutions?
- hyponatremia
- pulmonary edema
- cerebral edema
- hyperglycemia
- hyperkalemia
hypotonic saline solutions clinical applications?
- correction of free water deficit (Hypernatremia)
- maintenance of fluid therapy
increases both EC and IC volumes
risks of hypotonic saline solutions?
- hyponatremia
- pulmonary edema
- cerebral edema
characteristics of Colloid fluids?
- contains large proteins
- cause 1:1 ration of volume increase
- increase IV oncotic pressure
- risk of fluid overload
- controversial should be reserved for special situations
hypertonic crystalloids?
3% NaCl
5% NaCl
must be administered with extremeee caution(risk of ODS)
clinical applications of hypertonic crystalloids?
- severe hyponatremia
- cerebral edema
increases EC volume
decreases IC volume
risks of hypertonic crystalloids?
ODS
2 things about 0.45% NaCl fluid
Hypotonic
Used in hypernatremia (correct free water deficit)
Fluids in hypovolemic patient?
Isotonic fluid
Normal Saline (0.9%)
Switch to plasmalyte or LR if high volume
Fluids in hyponatremia
Hypertonic saline solution (3%)
Normal Saline
about colloidal solutions
controversial. should be preserved for special cases
high mW substances that remain confined to the intraVascular space –>generate oncotic pressure
they have greater effect on intraVascular volume than crystalloid
types of colloidal solutions?
natural:
- albumin
- FFP (fresh frozen plasma)
artificial:
- gelatin
- dextran
- hydroxyethyl starch (HES)
indication of colloidal solution?
acute hemorrhage
