IV Fluids and Bloods Flashcards
What are clinical signs of dehydration?
Dry mucous membranes
Loss of skin turgor
What are the following indicators for fluid resuscitation?
SBP
Pulse
Capillary Refill Time
Respiratory Rate
NEWS Score
JVP
Urine Output
Acid-base levels
Serum U&Es
Serum Osmolality
SBP <100 mmHg
Pulse >90
Capillary refill time >2 secs +/- cold peripheries
Respiratory rate >20 breaths
News 5+
JVP - raised if fluid overload
Urine output - decreased if dehydrated
Acid-base - disturbances occur in extremes of fluid states
Serum U&Es - will be raised in dehydration
Serum osmolality - will be increased in dehydration
How is passive leg raising used in terms of fluids?
If BP improves when legs are raised rather than legs down, it suggests fluid responsiveness.
What are the routine maintenance average requirements of a normal patient?
25-30ml/kg/day water
1 mmol/kg/day K, Na & Cl
50-100g /day glucose
How much water should be prescribed to a patient who more vulnerable (e.g. older, frailer, renal impairment, cardiac failure, malnourished or at risk of refeeding)?
20-25 ml/kg/day
Most patients don’t require more than how many litres per 24 hours?
Most patients do not require more than 3L fluid in 24 hours
What is refeeding syndrome?
Starvation - then food reintroduced - have low serum K, Mg and P as the cells pump these ions intracellularly along with glucose. Can cause pulmonary and neuro symptoms and can be fatal.
When a patient has severe oedema, how much of the fluid that you give a P will be lost to the interstitial area?
1/3 at least
Of fluids given to a sceptic patient, how much fluid will be lost into the EC space?
1/3 at least
Hypo and hypernatremia - how do these affect fluid levels?
Hyponatremia - means that the water will move intracellularly
Hypernatremia - the water will stay extracellularly in the intravascular space
For resuscitation - what volume of fluid should be given to patients in a bolus?
How should this be altered if they are older or have heart failure?
500ml over 15 mins
If older / CHF - this should be reduced to 250ml
When should you seek help with a patient in terms of amount of fluid given in a bolus?
When you have given 2L to a patient OR 1L if they are older Ps
What are the contents of 0.9% saline?
Sodium and Chloride
154 mmol/L Na
154 mmol/L Cl
308 Osmolarity
What are the contents of 5% glucose?
Water and sugar
277 mmol/L glucose
Osmolarity 278
What are the contents of Hartmann’s?
Na, K, Cl, Ca, HCO3
Na - 131 mmol/L
K - 5 mmol/L
Cl - 111 mmol/L
Ca - <0.5 mmol/L
What are the benefits and negatives of 0.9% saline solution?
Similar osmolarity to plasma - doesn’t rupture or dehydrate RBCs
Very salty - can cause. significant acid base abnormalities
What are the benefits of 5% glucose?
Glucose is metabolised to H20 and CO2 - so therefore you give the P pure water.
Which solution is the closest physiologically to blood?
Hartmann’s
What alternatives can be used to blood transfusion?
Erythropoietin (takes time)
IV & Oral Iron
Tranexamic acid
What is tranexamic acid used for?
To reduce interoperate bleeding and therefore reduce transfusion requirements
What are the rates of transfusion for the following?
Red blood cells
Platelets
FFP
Cryoprecipitate
RBCs - 1-2 hours - no slower than 4 hours
Platelets - 30-60mins
FFP - 10-20ml/kg/hour
Cryoprecipitate - quickly - 15-30 mins at a time
What is the difference between FFP and Cryoprecipitate
Both are made from plasma however cryo has more concentrated clotting factors in it such as Von Willebrand Factor, Factor 8 and fibrinogen
Which are the clinical S&S of a transfusion reaction?
Fever, chills or rigors
Hyper or hypotension
Collapse
Flushing
Urticaria
Pain (bone, muscle, chest, abdomen)
Nausea
Respiratory distress
General malaise
What are the 3 grades of transfusion reaction?
Mild, moderate or severe
