Resuscitation and Fluids & Electrolytes Flashcards
How to manage a lethargic and unconscious patient with SM and Shock and increased HR during infusion x2
- 15ml/kg Ringers lactate with 5% dextrose over 60 minutes
- Stop IV fluids and give frusemide 1mg/kg
Management of a conscious patient with SM and shock
5ml/kg resomal every 30 minutes for 2 hours PO/NGT
Maintenance fluids for shock and severe malnutrition x2
PO/NGT
1. 5ml/kg hourly alternating resomal with F75
2. If they do not tolerate give RL + 5% dextrose at IV maintenance rate
Management of shock and trauma x2
- Give 10ml/kg whole blood over 20 minutes, give the other 10ml/kg blood or NS/RL over 20 minutes if no improvement
(Max 40ml/kg for RL NS) - If there’s improvement give the other 10ml/kg over 2-3hours
Describe Plan C for infants
NS/RL 30ml/kg over 1 hour then 70ml/kg over 5 hours
Describe Plan c for children > 1 year
NS/RL 30ml/kg over 30 minutes and then 70ml/kg over 2.5 hours
Describe plan c for all patients x2
ORS 5ml/kg PO
Continue breastfeeding
Management of severe anemia and shock
20ml/kg while blood over 3-4 hours
Management of shock and severe infection
- Give 10-20ml/kg RS or NS over 30-60 minutes
- If not improvement give 10ml/kg over 30 minutes
Coma recovery position x3
Leg bent to support position
Arm bent to prevent rolling
Hand under chin to keep mouth open
Signs of seizures x4
Increased tone
Eyes deviated
Facial twitching
Abnormal repetitive movement
Describe plan A of dehydration x4
Increase frequency and volume of breastfeeding
2yrs: 50-100ml ors after loose stools
2yrs+: 100-200ml ors after loose stools
Give zinc
Describe plan B for dehydration
Breastfeeding and additional fluids
Give ors in 4 hours
4M: 200-450ml
4M to 12M: 450-800ml
12M to 2Y: 800-960ml
2Y to 5Y: 960-1600ml
State ions found in majority in ECF x3
Na, Cl, HCO3-
State ions found in majority in ICF x4
K, Mg, PO4-, organic anions
Causes of hypernatremia x4
Excessive salt intake
Diabetic insipidus
Volume losses
Poorly prepared formula
What causes the difference in ionic content between ECF and ICF x2
- Intracellular molecules do not cross the cell membrane ie barrier separating ECF and ICF
- Activity of the Na/K ATPase pump 3:2 ratio
When is ADH released and what is its function
Released when plasma osmolality is high and helps in reabsorption of fluid from the renal tubules
Contents of maintenance fluids x5
Na, K, Cl, water and glucose
When are replacement fluids given x2
Deficit replacement
Ongoing losses
Define acidemia and its 3 causes
Blood ph < 7.35
Primary metabolic- decrease in HCO3-
Primary respiratory - increase in pCO2
Mixed acid base disorder
Causes of metabolic acidosis x5
DKA
RTA - renal tubular acidosis
Medications eg salicylates
Diarrhea or other GI causes
Inborn errors of metabolism
2 causes of respiratory acidosis
Obstruction or lung parenchymal disease
Neuromuscular disease > respiratory muscle weakness
Signs and symptoms of hypernatremia x3
Thirst
Neurologic symptoms eg confusion, seizures, lethargy
Signs of hypovolemia
