front 1 Osmoles definition | back 1 Measure of the number of osmotically active particles in solution |
front 2 Molarity defitnition | back 2 Number of moles of a substance in a solution |
front 3 Water Distribution (in health) | back 3 Roughly a rule of 1/3rds… - 2/3rds of total body mass in water - 1/3rd of this is in the extra-cellular compartment - 1/3rd of this is in the intra-vascular compartment |
front 4 Standard formula for IV fluids regime | back 4
|
front 5 Loss in fever (sweat) | back 5 Water NaCl |
front 6 Loss in DM (Urine) | back 6 Glucose, water, KCl, NaCl, phosphate |
front 7 Loss in vomitting (gastric content) | back 7 HCl and water, KCl |
front 8 Loss in diarrhoea (faeces) | back 8 water, KCl, NaCl |
front 9 Loss in Burns (plasma, evaporation) | back 9 Protein, water, NaCl |
front 10 Ileostomy losses (ileal fluid) | back 10 water, NaCl |
front 11 Haemorrhage losses (blood) | back 11 RBCs all electrolytes |
front 12 Diabetes insipidus losses (urine) | back 12 water |
front 13 Addisons or diurteics use losses (urine) | back 13 NaCl, water |
front 14 sepsis, cirrhosis (third space) | back 14 Protein Nacl, water |
front 15 When do need to be cautious when giving fluids and consider individualisation of fluids regimes | back 15
|
front 16 Assessing fluids requirements | back 16
|
front 17 Hypovolemia (assessing fluid requirements) | back 17 clinical
Biochemical
|
front 18 Hypervolemia (assessing fluid requiremints) | back 18 Symptoms/Signs
Biochemical
|
front 19 Delivery mothods of IV fluids | back 19 Peripheral ◼ Venous cannula (Venflons) ◼ Intra-osseous ◼ (Subcutaneous) Central access: ◼ Central line ◼ Jugular, femoral, subclavian ◼ Peripherally-inserted central catheter (PICC) ◼ Hickman (tunnelled-line) ◼ Port-a-cath. Subcutaneous, accessible, needle-able reservoir |
front 20 Complications of Peripheral lines | back 20 ◼ Extravasation ◼ Thrombosis of peripheral veins ◼ Infection – phlebitis / cellulitis (VIP score to monitor, ANTT) ◼ Air embolism |
front 21 central line complications | back 21 ◼ Mis-insertion: pneumothorax, arterial bleed / dissection ◼ Infection – particular concern re: septic emboli / endocarditis ◼ Thrombosis and embolism ◼ Embolisation of the line ◼ Erosion ◼ Air embolism |
front 22 Prescribing Drug Chart | back 22 ◼ Dedicated section ◼ Can also be written on Once Only/Stat section ◼ State ◼ Type of fluid ◼ Volume ◼ Drugs/Electrolytes to be added ◼ Rate (mls/hr) AND/OR time to be given over ◼ (Signature + bleep) |
front 23 Prescribing Notes | back 23 ◼ Intention ◼ The intended fluid/electrolyte prescription over the next 24hrs ◼ Targets e.g. ◼ What to do if these are NOT met (for on-call Dr) ◼ Cautions/review points e.g. |
front 24 Crystalloid pros and cons | back 24 Pros ◼ Safe (save AE determined by volume/electrolytes) ◼ Cheap ◼ Constituents determine distribution ◼ Na+ - ECF, Dextrose – ECF/ICF Cons ◼ Remain in the intravascular space for less time (~45mins) ◼ Thus need greater volume to achieve effect (3-4L crystalloid/1L blood) |
front 25 colloid pros and cons | back 25 Pros ◼ Remain in the intravascular space (dependent on MW) ◼ Can act as ‘plasma expanders’ Cons ◼ Cost ◼ ‘Hidden’ electrolytes ◼ Potential allergens ◼ Effect coagulation (increased bleeding risk in high doses) ◼ Renal: (predominantly HES)(Osmotic nephrosis,Failure) |
front 26 common crystalloid fluids | back 26
|
front 27 electrolytes are normally added to | back 27 saline/sugar |
front 28 common colloid fluids | back 28
|
front 29 What is in Hartmanns (mmol/l) | back 29
|
front 30 Why Fluid Challenge? | back 30
How: ◼passive leg raise ◼ Fluid challenge (Deliver 250-500mls fluid via a largish-bore cannula over 5mins) Assess ◼ Clinical measures e.g. JVP/lungs/RR/HR/BP/UO ◼ Ideally: CVP, oesophogeal doppler ◼ NOT: Increase maintenance fluids |