Fluid resuscitation

Question 1

What is the BP for hypotension?

Answer 1

90/60 mmHg

Question 2

What causes endothelial dysfunction/capillary leak in sepsis?

Answer 2

Bacteria produce toxins
Toxins stimulate immune system to produce cytokines (TNFa)
Increase nitric oxide production in smooth muscle
Causes vasodilation, capillary leak and decreased intravascular volume

Question 3

What are the consequences of hypotension?

Answer 3

Hypoperfusion of organs
Hypoxia
Anaerobic metabolism
Lactic acid production
Metabolic acidosis

Question 4

What are some consequences of metabolic acidosis?

Answer 4

Exacerbates vasodilatation

Decrease myocardial contractility

Question 5

What are some signs of hypovolaemia?

Answer 5

Cool peripheries
Clammy 
Dry mucous membranes
Decreased JVP
Tachycardia
Hypotension
Skin turgor
Mottling of skin
Poor urine output

Question 6

What does elevated lactate in the blood suggest?

Answer 6

Tissue hypoperfusion/hypoxia

Question 7

What should the minimum urine output be?

Answer 7

0. 5ml/kg/hr

e. g. 30ml/hr for 60kg patient

Question 8

What fluid resuscitation increases the risk of anaphylaxis?

Answer 8

Colloids

Question 9

What fluids are used to re-hydrate patients?

Answer 9

Crystalloids

Question 10

Give some examples of crystalloids

Answer 10

0.9% sodium chloride

Hartmanns solution

Question 11

Give an example of a colloid

Answer 11

Gelofusin

Question 12

What is more expensive: crystalloids or colloids?

Answer 12

Colloids

Question 13

Name a natural colloid

Answer 13

Albumin

Question 14

Is there a risk of anaphylaxis when using albumin?

Answer 14

Yes but v small

Question 15

What is the most physiological colloid?

Answer 15

Blood

Question 16

What colloid also increases the oxygen carrying capacity of a patient?

Answer 16

Blood

Question 17

How should fluids be given initially in sepsis?

Answer 17

Fluid challenge

500-1000ml crystalloid stat

Then reassess

Repeat fluid as needed

Question 18

What should never be used as resuscitation fluid?

Answer 18

5% dextrose

Question 19

How much fluid do patients generally need to restore euvolaemia?

Answer 19

2litres

Better to give too much than not enough

Question 20

What is used to monitor response to fluids?

Answer 20

BP, HR and urine output

Repeat lactate may be useful

Question 21

If the patient does not respond to repeated fluids, what do they have?

Answer 21

Septic shock

Question 22

Name some vasoconstrictors

Answer 22

Noradrenaline - a agonist

Adrenaline - mixed a/b agonist

Question 23

What do vasconstrictors do?

Answer 23

Vasoconstrict and increase myocardial contractility

Question 24

When are vasconstrictors indicated?

Answer 24

Persistent hypotension despite optimised fluid resuscitation

Question 25

How are inotropes/vasconstrictors administered?

Answer 25

Central venous catheter