fluid therapydr indra
DESCRIPTION
fluid terapiTRANSCRIPT
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FLUID THERAPYDr Indragiri SpAn
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To Begin with:Body Fluid ,the balanceFluid disarrangementArtificial FluidTherapy and PracticesIon derangementIon and Acid base balance
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Body Fluid - The BalanceJUST SAY 60% AverageHuman body largely composed of fluids
Total body fluid ranges from 46 80%Decreased in the elderly
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Fluid depositionIntracellularExtra cellularIntravascular
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Composition Osmolarity = solute/(solute+solvent) Osmolality = solute/solvent (290~310mOsm/L) Tonicity = effective osmolality Plasma osmolility = 2 x (Na) + (Glucose/18) + (Urea/2.8) Plasma tonicity = 2 x (Na) + (Glucose/18)BALANCEION
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Composition
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Fluid disordersNormalIntravascular lossTotal body water deficitHipervolemia
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Electrolytes disorderNaKCa, mgBody Water
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Regulation
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Regulation
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Artificial body fluidTo have normal characteristic to natural body fluid.Normal measurement of - electrolyte - osmotic, oncotic pressure - pHNO SUCH A THING!!!!
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We Do Have..CRISTALOID, Saline, ringers, so onKOLOID, Gelatin, Starch, DextranPLASMA/ Albumin.
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Crystalloids
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Fluids in general
SolutionsVolumesNa+K+Ca2+Mg2+Cl-HCO3-DextrosemOsm/LECF1424510327280-310Lactated Ringers13043109282730.9% NaCl1541543080.45% NaCl7777154D5WD5/0.45% NaCl7777504063% NaCl51351310266% Hetastarch5001541543105% Albumin250,500130-160
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Parenteral FluidFluid therapy
1. Replacement fluids2. Maintenance of fluids3. Correction of electrolytes
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Fluid Management Goal: - to maintain urine output of 0.5~1.0mg/kg/h Rule: 4 2 -1 Electrolytes require: - Na+: 1-2mmol/kg/day - K+: 0.5~1.0mmol/kg/day Avoid fluid overload, especially in malnutrition, heart failure and renal insufficiency patient
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RESUCITATION For acute intravascular volume loss - Large borne IV line - Begin with 2-3L isotonic crystalloid to restore blood pressure and peripheral perfusion - Early use of colloid - Crystalloid + 5% albumin in a ratio of 4:1 - Blood transfusion
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DehydrationLoss of Total Body Water
Replace water deficit in 8 24 hours.Use resuscitation fluid.Normal Saline give you acidosis.Treat shock aggressively.
While doing resuscitation also give maintenance
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The DifferenceAcute Intra Vascular Volume loss
Heart rate, BP change first followed decrease interstitial volumeChronic volume Loss
Total body water deficit develop followed by HR, BP change
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Fluid Shifting in ResuscitationIntra vascularInterstitialIntra CellularMonitored in Vital SignMonitored in Metabolic values
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Fluid In Resuscitation1000cc500cc500cc500cc2006001000Lactated Ringers5% Albumin6% HetastarchWhole bloodBlood volumeInfusion volume
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Crystalloids Isotonic crystalloids - Lactated Ringers, 0.9% NaCl - only 25% remain intravascularly Hypertonic saline solutions - 3% NaCl Hypotonic solutions - D5W, 0.45% NaCl - less than 10% remain intra- vascularly, inadequate for fluid resuscitation
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Colloid Contain high molecular weight substancesdo not readily migrate across capillary walls Preparations - Albumin: 5%, 25% - Dextran - Gelifundol - Haes-steril 10%
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The Choice Crystalloids ColloidsIVVP Poor GoodHemod Stability Transient ProlongInfusate volume Large ModeratePlasma COP Reduced MaintainTissue edema Obvious InsignificAnaphylaxis Non-exist low-modCost Inexpensive Expensive
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The QuestionTwo Patients came with the same vital Sign, Lethargic, somnolence, BP 90/50, HR 160 bpm, RR 40. Body weight about 60 kg.Ones have traumatic amputation of right arm 2 hour ago, others had diarrhea for three days.How to manage this patients?
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