Emergency Medicine - fluids

Question 1

Intravenous fluid resuscitation - what are the 4 different fluid types that can be used?

Answer 1

1. Normal saline
2. Hartmann’s solution
3. 4-5% human albumin solution - if severe sepsis
4. Blood

Question 2

Intravenous fluid resuscitation - what is in Hartmann’s solution?

Answer 2

Sodium ions

Chloride ions

Potassium ions

Calcium ions

Lactate

Question 3

Intravenous fluid resuscitation - which fluids are not suitable for resuscitation?

Answer 3

Dextrose - because does not stay in intravascular department

Gelofusine - risks anaphylaxis

Question 4

Intravenous fluid resuscitation - what is the approach taken to administering fluids? How much fluid? Over what time period?

Answer 4

Initial resus - 500ml of fluid of choice, BUT
Use 250ml of fluid of choice in patients with cardiac disease or elderly - due to increased risk of pulmonary oedema secondary to excessive fluid resuscitation

Should be given over <15 minutes

Can be repeated if needed

If patient fails to respond after 2L of fluid, consider them non-responsive, seek help, may need BP support in critical care

Question 5

Assessing fluid status - how do you assess fluid status?

Answer 5

ABCDE approach

Question 6

What are some indications a patient may require fluid resus?

Answer 6

NEWS ≥5
Systolic BP <100
Cool peripheries
Cap refill >2s
HR >90bpm
Resp rate >20
Dry mucous membranes

Question 7

What are some conditions that indicate IV fluids?

Answer 7

1. Patient nil by mouth (bowel obstruction, ileus, pre-op)
2. Severe D+V
3. Hypovolaemic as a result of blood loss (also needs blood products)

Question 8

What are the two major groups IV fluids can be categorised into? What are fluid examples for each?

Answer 8

Crystalloids - solutions of small molecules in water like sodium or chloride (Sodium Chloride 0.9% ie normal saline, Hartmann’s, Dextrose)

Colloids - solutions of larger organic molecules (Albumin, Gelofusine)

Question 9

What risk does using colloid fluids carry with it?

Answer 9

Carry a risk of anaphylaxis

Question 10

Which is better in initial fluid resus, crystalloid or colloid?

Answer 10

Crystalloid shown to be superior in initial fluid resus

Question 11

What are the steps in fluid resuscitation?

Answer 11

1. Administer initial 500ml (or 250ml) bolus over 15 mins
2. After 15mins, reassess using ABCDE approach, looking for evidence of fluid response
3. If still ongoing hypovolaemia or other symptoms, give another 250-500ml bolus, then reassess using ABCDE approach
4. Repeat until 2000ml given
5. If fluid unresponsive, seek expert help

Question 12

Table for commonly used fluids

Answer 12

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