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Y6 PSA > Fluids + Oxygen > Flashcards

Fluids + Oxygen Flashcards

1
Q

For which conditions do you give dextrose instead of saline?

A

Hypernatraemic
or
Hypoglycaemic

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2
Q

What fluid bolus do you give if HR high /BP low?

A

500ml bolus over 15 minutes > then reassess

Max. 2 L this way

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3
Q

What do you give when low UO, but no obstruction?

A

1L over 2-4hours > reassss

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4
Q

What do you givee for maintainance fluid?

A

1L Nacl + 40mmol K+ over 8-12h

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5
Q

What is daily requirement of fluid per day (as formula)?

A

25-30 mL/kg/day

Adjust for frailty, body size, renal/cardiac function and current body status

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6
Q

What are requirements of glucose per day?

A

50-100g/day&raquo_space; 1L of 5% dextrose is 50g of glucose&raquo_space; enough for one day

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7
Q

What is potassium requirement you need to give per day

A

60mmol

More specifically: 1mmol/kg/day

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8
Q

How does K+ come in bags?

A

It comes in bags of 20 or 40

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9
Q

what is the highest K+ concentration you can put in 1L saline

A

40 mmol/L (more than this causes irritation)

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10
Q

What is the max K+ concentration you can give per hour

A

10mmol/h
20mmol/h with monitoring (more than this will cause arrythmia)

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11
Q

Give example of standard daily fluid regimen

A

8 hourly 1L saline + 40mmol K+
8 hourly 1L saline + 20mmol K+
8 hourly 1L 5% dextrose + 20mmol K+

Adults need 3L over 24 hours.

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12
Q

Fluid management for HYPOnatraemia

A

Fluid restrict
SLOW IV normal saline

Risk of cerebral pontine myelinolysis if replaced too quickly

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13
Q

Fluid management for HYPERnatraemia

A

Slow IV normal saline

Risk of replacing quickly: cerebral oedema

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14
Q

When a patient is recovering from an AKI, what does it mean if heir urine output increases beyond their fluid input?

A

Patients may enter a ‘polyuric phase’ - urine output exceeding 200 mL/h should always prompt consideration of this phenomenon.

Calculate how much the patient is losing per hour e.g. 1L lost every 4 hours and match the fluid input accordingly.

Don’t forget to correct for electrolyte abnormalities at the same time

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15
Q

When is FFP given?

A

Used to correct deranged clotting (where PT/APTT is >1.5 times the normal)

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16
Q

What are the main indications of using sodium chloride over hartmans/ compound sodium lactate solution?

A

Usually in sodium depletion, which can arise from such conditions as
* gastro-enteritis
* diabetic ketoacidosis
* ileus
* and ascites
* And prefered in head injury: hyper-osmolar therefore reduced likelyhood of cerebral oedema

But: risk of hyperchloraemic acidosis

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17
Q

What are usual dails fluid requirements in the adult?
(Volume, Electrolytes and urine output)

A

Fluids: 25-30 ml/kg water (~2-3L IV)
Electrolytes: 1mmol/kg NA, CL, K+
Urine output: 0.5mg/kg/h

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18
Q

What are contraindications to the administration of Hartman’s?

A
  1. Liver failure - cannot metabolise lactate
  2. Hyperkalaemia - renal failure
19
Q

What would be a common maintenance fluid prescription for a healthy adult?

A

Usually 1 salty 2 sweet (some argue 2 salty 1sweet) + Potassium

= 8hrl bags with 20mmol K+ per bag

20
Q

What is the maintenance requirement of potassium for a patient with a normal potassium level?

A

Aim for between 40-80 mmol/ day (1mmol/kg/day)

21
Q

What is the maximum rate of infusion of potassium?

A

Maximum rate of delivery: 10mmol/h (or 20mmol/h in ICU)

22
Q

When should you replace potassium orally, and when should you think about IV replacement?

A

2.6 - 3.4: Oral replacement
if < 2.5: IV replacements

  • 40mmol of Potasssium in 1L = 0.3%
  • 20mmol of Potassium in 1L = 0.15%
23
Q

What are some contraindications to thrombophrophylaxis in hospital?

A

Acute bleeding risk (including recent ischaemic stroke)

24
Q

What are contraindications to compression stockings?

A

Peripheral arterial disease

25
Q

When is BiPAP useful?

A

COPD and atelectasis

26
Q

When is CPAP useful?

A

Heart failure and obstructive sleep apnoea

27
Q

When are venturi masks useful?

A

In patients dependent on hypoxic respiratory drive (e.g. COPD) as fixed amount of O2 will be given

28
Q

Fluids for emergency resus

A

sodium chlroide 0.9% 500ml 15 min (10 mins also okay)

29
Q

Fluids for emergency hypoglycaemia

A

glucose 20% 100ml 15 mins

30
Q

Fluids for emergency hypokalaemia

A

sodium chloride 0.9% / potassium chloride 0.3% 1000ml 4hour

31
Q

Fluids for emergency hypercalaemia

A

sodium chloride 0.9% 1000ml 4 hr

32
Q

Maintenance fluids w/o losses

A

25-30 ml/kg/24hr water
1mmol Na Cl K
50-100g glucose

8-12 hrs 1000ml

33
Q

Maintanence fluids with losses

A

30 ml/kg/24hr water
ensure electrolytes replaced

4-6hrs

34
Q

Hyperkalaemia mx in children

A

soluble insulin (0.3–0.6 units/kg/hour in neonates and 0.05–0.2 units/kg/hour in children over 1 month)

with glucose 0.5–1 g/kg/hour (5–10 mL/kg of glucose 10%; 2.5–5 mL/kg of glucose 20% via a central venous catheter may also be considered).

35
Q

Algorithm for deciding type of IV fluids by indication in infants

A
36
Q

What is the routine maintenance fluid for a child (>28 days old)?

A

For a child (>28 days of age), first line maintenance fluid is usually isotonic crystalloids + 5% glucose (e.g. 0.9% sodium chloride + 5% glucose).

37
Q

What is the routine maintenance fluid for a neonate?

A

No critical illness: 10% dextrose +/- additives

Critical illness (e.g. infantile respiratory distress syndrome, meconium aspiration): seek expert advice (use fluids with no/minimal sodium initially)

38
Q

Equation to calculate 24 hour routine maintenance fluid amount in children

A

100 ml/kg/day for the first 10kg of weight
50 ml/kg/day for the next 10kg of weight
20 ml/kg/day for weight over 20kg

For neonates: calculated according to day of life:
Birth to day 1: 50-60 ml/kg/day
Day 2: 70-80 mL/kg/day
Day 3: 80-100 mL/kg/day
Day 4: 100-120 mL/kg/day
Days 5-28: 120-150 mL/kg/day

39
Q

What are the maintenance fluid requirements for neonates (<28 days)?

A

Birth to day 1: 50-60 ml/kg/day
Day 2: 70-80 mL/kg/day
Day 3: 80-100 mL/kg/day
Day 4: 100-120 mL/kg/day
Days 5-28: 120-150 mL/kg/day

40
Q

Resus in children

A

standard bolus of 10 mL/kg over <10 minutes

Fluid: 0.9% sodium chloride or Hartmann’s

41
Q

Risk with rapid correction of severe hyponatraemia

A

central pontine myelinolysis

42
Q

Risk with rapid correction of severe hypernatraemia

A

cerebral oedema

43
Q

Children on IV fluids should have what checked once daily?

A

U&Es
Glucose

Y6 PSA (32 decks)

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