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Final Year - Emergency Med > IV fluids - Dr Alice Ditchfield > Flashcards

IV fluids - Dr Alice Ditchfield Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Give some broad indication categories for IV fluids

A

Maintenance
Replacement
Resus

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2
Q

Maintenance indications - examples

A

NV
NMB
If not absorbing

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3
Q

Replacement indications - examples

A

GI loss
Sweating 3rd burns
Surgery
D and V

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4
Q

Resus indications - examples

A

Shock
Anaphylaxis

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5
Q

How much of total body weight is intracellular fluid?

A

2/3

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6
Q

How much of total body weight is extracellular fluid?

A

1/3

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7
Q

Extracellular fluid can be split into

A

Interstitial fluid (between cells)
Plasma
Transcellular fluid (within epithelial linings/glands, aka secretions

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8
Q

What portion of extracellular fluid is interstitial?

A

3/4 is interstitial

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9
Q

What portion of extracellular fluid is in plasma?

A

Only 1/4

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10
Q

What is osmolality and what is the normal range?

A

It is the concentration of a solution, expressed as solutes per kg

Normal - 275-295 mili osmoles per kg

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11
Q

What are the three types of fluid we can give?

A

Crystalloids
Colloids
Blood

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12
Q

Name three types of crystalloids

A

Hypotonic solution (would make fluid leak out of blood)
Isotonic solution (Hartmanns)
Hypertonic solution (would draw fluid into blood)

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13
Q

Give two examples of isotonic solutions

A

Hartmanns - 270+ osmoles
NaCl 0.9 percent - 300+ osmoles

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14
Q

What is another name for Hartmann’s

A

Compound sodium lactate

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15
Q

When can you not given Hartmann’s and why

A

Liver failure - inability to metabolise lactate
Renal failure - risk of hyperkalemia

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16
Q

Give an example of a colloid

A

Human albumin solution

17
Q

Resus regimen

A

500ml 0.9 percent NaCl, or 250ml if elderly/with co-morbidities

18
Q

Maintenance regimen

A

1 salty, 2 sweet
e.g. (not complete picture, see next flashcard)

500ml 0.9percent NaCl over 8 hours
1L 5 percent dextrose over 8 hours
500ml 5 percent dextrose over 8 hours

19
Q

What do you need to remember to add to the maintenance regimen?

A

POTASSIUM

aka

500ml 0.9percent NaCl + 20mmol POTASSIUM
1L 5 percent dextrose + 20mmol POTASSIUM
500ml 5 percent dextrose + 20mmol POTASSIUM

20
Q

If someone has hypokalemia, how much potassium can you add to the NaCl bag

A

40mmol

21
Q

What is the maximum rate of potassium delivery via IV

A

10mmol/hr

22
Q

ECG changes in hypokalemia

A

T wave flattening
U wave
Prolonged QT interval

23
Q

ECG changes in hyperkalemia

A

Tall tented T waves
Broadened QRS
Wide PR interval

24
Q

Management of hyperkalemia

A

Repeat VBG
Double check that the bloods are haemolysed

10ml 10 percent calcium gluconate
50ml 50 percent dextrose over TEN MINUTES
10 units of Actrapid
Salbutamol nebs 5mg (max 4 times)
Check U and Es 4 hrs later
Repeat ECGs
Consider haemodialysis for refractory hyperkalemia

25
Q

Normal range for calcium

A

2.2-2.6mmol

26
Q

Symptoms of hypocalcemia

A

Muscle cramps
Convulsions
Arrhythmias
Tetany - Trussau’s carpopedal spasm in response to BP cuff, or Chvostek’s sign - tapping the cheek in front of the ear causes facial spasm
Parasthesias

27
Q

What’s the management of hypocalcaemia?

A

> 1.9 - Adcal
<1.9 - monitor heart, give IV calcium gluconate

Remember to replace any low magnesium?

28
Q

Management of hypercalcemia

A

IV fluids
Bisphosphonate

29
Q

Normal range for phosphate

A

0.5-1.5

30
Q

Management of hypophosphatemia

A

Phosphate sandoz tables

31
Q

Normal range of magnesium

A

0.7-1

32
Q

Management of low magnesium

A

> 0.41 - oral tablets
<0.4 - IV mag sulf 20mmol in 250ml NaCl over 6 hours

33
Q

In a head injury what do you give

A

NORMAL SALINE because you don’t want to shift the fluids in the brain too quickly

Final Year - Emergency Med (9 decks)

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