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Fluid Management. 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 Invasive testing– a-line, CVP, Swan.
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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
Are you dry sir? Have some high test. • Crystalloid • Colloid • Blood products
Crystalloid • D5W • LR • NaCl • Plasmalyte • Hyper, iso, hypotonic • Salts • Maintenance v. replacement
Colloid • Starches – penta, heta • Albumin – Heated 60C for 10h, not infectious • Blood – later secret slides • Oncotically active • Long T1/2 • SAFE Trial
Periop Fluid Mx • How much volume do I start with? • How much do I loose? • How much do I give back?
How should I get started? • 4,2,1 rule • Deficit • Losses– secretions, blood, third spacing, urine, sweating, evaporation, other… • Stress of operation
Blood Transfusion • ABO system • Rh system • Typing • Screening • Cross Matching • Time
What’s in blood anyway? • Whole blood • PRBCs • FFP • Platelets • Cryo
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
Massive Transfusions • Rapid infusers • Coagulopathy • Citrate tox • Hypothermia • Acid/base balance • Potassium
Since blood has risk… • Autologous transfusion • Blood salvage and reinfusion • Normovolemic hemodilution • Donor directed transfusion
If you wanted to read on your own…. • Morgan and Michail Chapter 29. Third edition.