Circulation Tutorial

Question 1

What is a fluid status?

Why is it measured?

Answer 1

Amount of a patient’s extracellular fluid

Helps narrow down condition and treatment

Question 2

What is meant by the terms:

Hypovolaemia
Euvolaemia
Hypervolaemia

Answer 2

Hypo = low extracellular fluid leading to tachycardia, hypotension and tachypnoea

Eu = normal extracellular fluid leading to normal HR, BP and RR

Hyper = high extracellular fluid leading to bradycardia, hypertension and normal RR or tachypnoeic

Question 3

What conditions may lead to hypovolaemia?

Answer 3

Bleeding
Dehydration
Liver failure, kidney failure, heart failure

Question 4

What happens in the video?

Answer 4

S = acutely unwell, 52M, 5 day history of abdominal pain

B = T2DM

A = no treatment due to IV access difficulty

R = concerned, needs a review

Question 5

What does the patient have?

Answer 5

Tachycardia, hypotension and tachypnoea

Question 6

His observations show:

HR 133
BP 94/53
Sats = 96% on air
T = 38.2
RR of 24

What oxygen flow rate would be suitable for a non-rebreathe mask?

Why is he given oxygen despite his sats being normal?

Answer 6

15L/min

To help lower his RR - increased RR compensating for poor O2 perfusion due to low BP (vasodilation all over the body)

Question 7

What does the doctor find on the patient during the ABCDE assessment?

Answer 7

Normal capillary refill time 
Fever
High HR 
High RR 
Low BP

Question 8

What is the likely diagnosis?

Answer 8

Sepsis - high HR, low BP, and fever

Due to appendicitis - due to abdominal pain history

Question 9

What are the sepsis 6?

When should the sepsis 6 be done to maximise chances of survival?

Answer 9

3 in:
Give oxygen
Give fluids
Give antibiotics

3 out:
Take lactate
Take blood cultures
Take urine output - catheter

Must be done within the first hour - max chances of survival