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Fluid Management

Fluid Management . Karl Wagner MD MHMC August 2007. Fluids are good right? Sky’s the limit?. How do I know someone needs fluid?. Physical Exam– HR, BP, Mucous membranes, UOP, Orthostatics, Sensorium Lab evaluation– Hct, pH, urine specific gravity, Sodium (urine and serum), chloride, BUN/Cr

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Fluid Management

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  1. Fluid Management Karl Wagner MD MHMC August 2007

  2. Fluids are good right?Sky’s the limit?

  3. How do I know someone needs fluid? • Physical Exam– HR, BP, Mucous membranes, UOP, Orthostatics, Sensorium • Lab evaluation– Hct, pH, urine specific gravity, Sodium (urine and serum), chloride, BUN/Cr • Invasive testing– a-line, CVP, Swan

  4. Are you dry sir? Have some high test. • Crystalloid • Colloid • Blood products

  5. Crystalloid • D5W • LR • NaCl • Plasmalyte • Hyper, iso, hypotonic • Salts • Maintenance v. replacement

  6. Colloid • Starches – penta, heta • Albumin – Heated 60C for 10h, not infectious • Blood – later secret slides • Oncotically active • Long T1/2 • SAFE Trial

  7. Periop Fluid Mx • How much volume do I start with? • How much do I loose? • How much do I give back?

  8. How should I get started? • 4,2,1 rule • Deficit • Losses– secretions, blood, third spacing, urine, sweating, evaporation, other… • Stress of operation

  9. Blood Transfusion • ABO system • Rh system • Typing • Screening • Cross Matching • Time

  10. What’s in blood anyway? • Whole blood • PRBCs • FFP • Platelets • Cryo

  11. Complications • Hemolytic reactions– acute, delayed • Nonhemolytic reactions – Febrile, urticarial, anaphylactic, TRALI, Graft v. host, post transfusion purpura, immunosuppression • Infections – HIV, Hep a-z, CMV, parasites and bacteria

  12. Massive Transfusions • Rapid infusers • Coagulopathy • Citrate tox • Hypothermia • Acid/base balance • Potassium

  13. Since blood has risk… • Autologous transfusion • Blood salvage and reinfusion • Normovolemic hemodilution • Donor directed transfusion

  14. If you wanted to read on your own…. • Morgan and Michail Chapter 29. Third edition.

  15. Go forth and fill the intravascular space

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