Fluid resuscitation Flashcards Preview

Year 2 Sepsis > Fluid resuscitation > Flashcards

Flashcards in Fluid resuscitation Deck (25)
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1
Q

What is the BP for hypotension?

A

90/60 mmHg

2
Q

What causes endothelial dysfunction/capillary leak in sepsis?

A

Bacteria produce toxins
Toxins stimulate immune system to produce cytokines (TNFa)
Increase nitric oxide production in smooth muscle
Causes vasodilation, capillary leak and decreased intravascular volume

3
Q

What are the consequences of hypotension?

A
Hypoperfusion of organs
Hypoxia
Anaerobic metabolism
Lactic acid production
Metabolic acidosis
4
Q

What are some consequences of metabolic acidosis?

A

Exacerbates vasodilatation

Decrease myocardial contractility

5
Q

What are some signs of hypovolaemia?

A
Cool peripheries
Clammy 
Dry mucous membranes
Decreased JVP
Tachycardia
Hypotension
Skin turgor
Mottling of skin
Poor urine output
6
Q

What does elevated lactate in the blood suggest?

A

Tissue hypoperfusion/hypoxia

7
Q

What should the minimum urine output be?

A
  1. 5ml/kg/hr

e. g. 30ml/hr for 60kg patient

8
Q

What fluid resuscitation increases the risk of anaphylaxis?

A

Colloids

9
Q

What fluids are used to re-hydrate patients?

A

Crystalloids

10
Q

Give some examples of crystalloids

A

0.9% sodium chloride

Hartmanns solution

11
Q

Give an example of a colloid

A

Gelofusin

12
Q

What is more expensive: crystalloids or colloids?

A

Colloids

13
Q

Name a natural colloid

A

Albumin

14
Q

Is there a risk of anaphylaxis when using albumin?

A

Yes but v small

15
Q

What is the most physiological colloid?

A

Blood

16
Q

What colloid also increases the oxygen carrying capacity of a patient?

A

Blood

17
Q

How should fluids be given initially in sepsis?

A

Fluid challenge

500-1000ml crystalloid stat

Then reassess

Repeat fluid as needed

18
Q

What should never be used as resuscitation fluid?

A

5% dextrose

19
Q

How much fluid do patients generally need to restore euvolaemia?

A

2litres

Better to give too much than not enough

20
Q

What is used to monitor response to fluids?

A

BP, HR and urine output

Repeat lactate may be useful

21
Q

If the patient does not respond to repeated fluids, what do they have?

A

Septic shock

22
Q

Name some vasoconstrictors

A

Noradrenaline - a agonist

Adrenaline - mixed a/b agonist

23
Q

What do vasconstrictors do?

A

Vasoconstrict and increase myocardial contractility

24
Q

When are vasconstrictors indicated?

A

Persistent hypotension despite optimised fluid resuscitation

25
Q

How are inotropes/vasconstrictors administered?

A

Central venous catheter