Resuscitation

Question 1

How does intubation affect the action of the heart?

Answer 1

-Reduced venous return-

MOA: Intubation means pumping air in to the lungs, it is indicated for when someone isn’t able to breath manually.

This causes positive pressure within the lungs, normally during inspiration pressure is negative, but with positive intrathoracic pressure the heart is compressed and return of blood to the heart is reduced.

Question 2

How can we assess a patient’s haemodynamic status?

Answer 2

General observations:
Skin colour
Breathing difficulties
Distended veins

Upper limbs:
Capillary refill
Pulse volume and character
BP

Face:
Tongue
Conjunctiva

Neck:
JVP
Carotid pulse volume and character

Bedside X-ray

Question 3

Fluid resuscitation: how much is the bolus volume for resuscitation?

Answer 3

500ml

250ml if elderly or they have cardiac problems (HF etc)

Tests fluids are for hypovolaemia.

Note: maintenance fluids are generally for poor oral intake or chronic issues - approx 30ml/kg/day