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FLU ID M AN AG EM EN T

Rabin BhandariDept. of GP and Emergency

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Fluid Management

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FLU ID M AN AG EM EN T

Good veins are best but can you fnd them? What are the 3

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Doctor, Doctor!W e’ve lost our IV!

ubcla!ian"

#nternal $ugular

%#$&" Femoral"

'mbilical (rtery %'(

'mbilical *ein %'*)&

#ntrao++eu+ %#,&

 All patients Peds only 

'tili-e eldinger techniue/ +ee handout

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Fluid types

)ry+talloid+

)olloid+

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Crystalloids vs Colloids

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Practical Rule 1

IV inusion o1 litre uid

ECF ICF remars

.45 +aline 16 7a remain+ inE)F

5 gluco+e 3336 6 5 i+ #)F

.05 +aline 6 3336 335 i+ E)F

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Crystalloids

!olution "a#

Cl$

% #

Ca#&

'C()$

Glu

*lasma1+1 1,) +$- - &. ,

"! 1-+ 1-+ , , , ,

/-W , , , , , -, G

0 1), 1,2 + ) &3 ,

Serum Osmolality = [2 x Na] + [BUN/2.8] + [glucose/18]

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NS vs. LR

10 me 7a: )l

,ften ha+ 2 me

;)luid

?ith ;)l added

p@ .8/ 39m,+m

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W hat aout D W "

Poor !olume epander % ccintra!a+cular

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Practical rule #

Pre ei+ting decit

Maintenance

(bnormal lo++e+

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$ssessi%& dehydratio%

   M i l  d    •   R  e  d  u  c  e  d

  t  u  r  g  o  r :  +  u  n  C  e  n  e  y  e  + :  d  r  y   m  u  c  o  u  +   m  e   m  b  r  a  n  e

   M  o  d  e  r  a  t  e    •   , l i  g  u  r i  a :  o  r  t  h  o  +  t  a  t

 i  c  h  y  p  o  t  e  n  + i  o  n :  t  a  c  h  y  c  a  r  d i  a   6  a  b  o  !  e

    e  !  e  r  e    •  P  r  o  f  o  u  n  d  o l i  g  u  r i  a

  a  n  d  c  o   m  p  r  o   m i  +  e  d  c  a  r  d i  o  !  a  +  c  u l  a  r  f  u  n  c  t i  o  n

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Rehydratio%

4(05! 1H2 = %7 or =R&

67I"8E"7"CE 8H12 cc

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INDIC$'(RS (F S)CC*SSF)LR*S)SCI'$'I(N

P'=E 1 H 12 bpm

'R#7(RJ ,'P' )@#=DRE7 K 1. ml

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Fluid overload

Lhat do you looC forI

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Case Studies

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'he ur% patie%t

2 year male: caught re after hi+ ga++to!e caught re .

 he patient +u+tained +econd and thirddegree burn+ e+timated at 0 5 total

body +urface area.

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Par+la%d For ula

+ cc 9 WEIG'8 :;< 9 :=84!7<

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Par+la%d *-a ple

2 year old male

?eight K 1Cg

05 B( 2 H 3 burn+

@o? much >uid do you need to gi!eI

During the r+t 9 hour+I During the net 1 hour+I

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Par+la%d *-a ple

0 cc ?eight 5B(

0 1 0 K 1: cc

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Polytrau a

3 year+ male

Polytrauma

(bdominal di+ten+ion ?ith o!erlyingbrui+e and guarding

BPH 8

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'o tra%s.use or %ot to

tra%s.use/ @) N3

(cute on+et

Pt +ymptomatic Pre+yncopal

@ypoten+i!e

 achycardic

 achypneic

,ther +tre++or+imminent

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0lood Products

Lhole blood

PacCed RB)A+ Fre+h fro-en pla+ma

%FFP&

)ryoprecipitate

Platelet+

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'he Co patiility a e

(B, compatibility Recipient can only

recei!e (B, protein+

he

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0lood is 0lood, ri&ht"

Lhole blood *olume

epander 3 d +helf life

PacCed RB)A+

a!e+ !olume%2 cc&

02 d +helf life

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Resuscitatio%

)ry+talloid+ Replace blood lo++ at a 31 ratio

#nitial bolu+ 1H2 liter+: u+ually normal

+aline

#f they ha!e tran+ient re+pon+e: gi!eadditional >uid+. ,nce 3H0 liter+ ofcry+talloid ha+ been gi!en con+iderblood.

2