CME FLUID RESUSCITATION MALAYSIA BY TSAQOLAIN RASIP.pptx
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Describe the physiology of human fluid dynamics.
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List the aims of adult perioperative fluid therapy.
Recognize the commonly used fluid preparations.
Describe the properties and indications of widely used IV solutions.
Describe the side effects and precautions of widely used IV solutions.
Explain the (NICE) principles and protocols for intravenous fluid therapy.
Discuss the assessment and management of hydration and volume status of surgical patients.
Describe the type, rate, and volume of fluid administered to surgical patients.
Recognize the different types of venous access.
Explain the potential local complications of peripheral IV therapy.
Identify the universal equations used by nurses to calculate the IV flow rate and medication dosage.
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1) Fluid and electrolyte balance is essential for human health and involves complex regulation of water and electrolytes like sodium and potassium in the body.
2) Imbalances can cause hypo- or hypervolemia and issues like hyponatremia or hyperkalemia.
3) Treatment depends on the cause and aims to restore normal fluid volume and electrolyte levels, using oral or IV fluids and monitoring for complications.
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1. The document discusses fluid and electrolyte balance and disturbances, focusing on sodium, potassium, fluid volume deficits, and fluid volume excesses. It describes the regulation of body fluid compartments and how electrolyte imbalances can occur.
2. Specific electrolyte imbalances like hyponatremia, hypernatremia, hypokalemia, and hyperkalemia are explained in terms of their causes, clinical manifestations, and nursing management.
3. Critical thinking exercises are provided to help nurses understand how to assess and care for patients experiencing fluid and electrolyte disturbances like hyponatremia and hypokalemia. Monitoring, diet modifications
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This document discusses fluids and electrolytes, covering several key points in 3 sentences or less:
Fluids and electrolytes are essential for maintaining homeostasis, as water makes up 50-60% of the human body and is needed for transport of nutrients, wastes, and substances. Fluids enter and leave the body through various avenues like the intestines, kidneys, and skin and are regulated by mechanisms such as ADH and aldosterone to control water resorption and excretion. Imbalances in fluids can cause deficits or excesses that disrupt homeostasis and must be managed through monitoring intake and output, administering IV fluids, and addressing the underlying causes.
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This document discusses fluid and electrolyte imbalance. It begins by defining electrolytes and homeostasis. It then describes the distribution of body fluids and the mechanisms controlling fluid and electrolyte movement. Key hormones that regulate fluid and electrolyte balance are discussed including aldosterone, antidiuretic hormone, and atrial natriuretic peptide. Abnormalities in fluid volume such as deficits and excesses are explained. Specific electrolyte imbalances like hyponatremia, hypernatremia, and hypokalemia are then defined and their etiologies, pathophysiology, clinical manifestations, and treatment approaches are summarized.
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The document discusses fluid compartment and distribution in the body. It notes that total body water decreases with age and is lower in females due to higher fat content. Total body water is divided into intracellular fluid and extracellular fluid. Electrolyte concentrations also differ between intracellular fluid and extracellular fluid. The document then covers basic concepts of fluids including osmosis, osmotic pressure, and tonicity. It also discusses types of intravenous fluids, hypovolaemia, fluid challenges, and phases of septic shock including a flow phase and global increased permeability syndrome. Fluid overload in critically ill patients is described as being inevitable without careful fluid management.
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- Fluid therapy requires selecting the appropriate intravenous fluid based on the patient's condition, including their electrolyte and acid-base disorders.
- In hypovolemic shock, isotonic saline is preferred, while colloids are most effective but costly. Ringer's lactate is preferred if larger volumes are needed.
- In diarrhea, Ringer's lactate is preferred. In vomiting, isotonic saline with potassium is used. For combined losses, isotonic saline with potassium works best.
- In hepatic encephalopathy and stroke, maintenance of euvolemia is key, avoiding hypotonic fluids and electrolyte imbalances that could worsen the conditions.
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This document discusses fluid and electrolyte balance, imbalances, and treatment. It covers maintaining balance through the kidneys, adrenal glands, and ADH hormone. Common imbalances are fluid volume deficit and excess. Fluid volume deficit can be isotonic, hypertonic, or hypotonic and is assessed through various systems before being treated with oral or IV fluid replacement. Fluid volume excess can also be isotonic, hypertonic, or hypotonic and is assessed in a similar way before being treated with diuretics and fluid restriction.
Fluid balance for surgical patients. Dr. Ahmed khashaba, MD
Intended Learning Outcomes:
Describe the physiology of human fluid dynamics.
Define Intravenous therapy.
List the aims of adult perioperative fluid therapy.
Recognize the commonly used fluid preparations.
Describe the properties and indications of widely used IV solutions.
Describe the side effects and precautions of widely used IV solutions.
Explain the (NICE) principles and protocols for intravenous fluid therapy.
Discuss the assessment and management of hydration and volume status of surgical patients.
Describe the type, rate, and volume of fluid administered to surgical patients.
Recognize the different types of venous access.
Explain the potential local complications of peripheral IV therapy.
Identify the universal equations used by nurses to calculate the IV flow rate and medication dosage.
Fluid and electrolytes
This document provides an overview of fluid and electrolyte management in surgical patients. It discusses the normal composition and homeostasis of body fluids, as well as different types of intravenous fluids including crystalloids and colloids. It then covers perioperative fluid therapy and management of common electrolyte imbalances like sodium and potassium. The key goals are to maintain adequate intravascular volume and tissue perfusion while avoiding complications from fluid overload or electrolyte abnormalities.
Fluid and electrolyte
1) Fluid and electrolyte balance is essential for human health and involves complex regulation of water and electrolytes like sodium and potassium in the body.
2) Imbalances can cause hypo- or hypervolemia and issues like hyponatremia or hyperkalemia.
3) Treatment depends on the cause and aims to restore normal fluid volume and electrolyte levels, using oral or IV fluids and monitoring for complications.
Fluid and electrolytes, balance and disturbances (1)
1. The document discusses fluid and electrolyte balance and disturbances, focusing on sodium, potassium, fluid volume deficits, and fluid volume excesses. It describes the regulation of body fluid compartments and how electrolyte imbalances can occur.
2. Specific electrolyte imbalances like hyponatremia, hypernatremia, hypokalemia, and hyperkalemia are explained in terms of their causes, clinical manifestations, and nursing management.
3. Critical thinking exercises are provided to help nurses understand how to assess and care for patients experiencing fluid and electrolyte disturbances like hyponatremia and hypokalemia. Monitoring, diet modifications
Fluids and Electrolytes
This document discusses fluids and electrolytes, covering several key points in 3 sentences or less:
Fluids and electrolytes are essential for maintaining homeostasis, as water makes up 50-60% of the human body and is needed for transport of nutrients, wastes, and substances. Fluids enter and leave the body through various avenues like the intestines, kidneys, and skin and are regulated by mechanisms such as ADH and aldosterone to control water resorption and excretion. Imbalances in fluids can cause deficits or excesses that disrupt homeostasis and must be managed through monitoring intake and output, administering IV fluids, and addressing the underlying causes.
Fluid management in pd patient
This document summarizes key aspects of fluid management in peritoneal dialysis (PD) patients. It discusses optimizing PD prescriptions to balance adequate solute clearance while avoiding excess dialysis fluid exposure. Factors like residual renal function, membrane characteristics, fill volume and dwell time are considered. Monitoring adequacy includes measuring clearances and adjusting therapy if targets are not met. Guidelines recommend strategies to preserve renal function like ACEi/ARB use and avoiding dehydration.
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This document discusses best practices for perioperative fluid management. It notes that perioperative fluid management can be complicated due to factors like fasting, bowel preps, and surgical stress that can cause fluid and electrolyte imbalances. The goals of perioperative fluid management are hemodynamic stability, adequate tissue perfusion, avoidance of fluid overload, and avoidance of acute kidney injury in order to achieve best surgical outcomes. Different fluid management strategies are discussed for the preoperative, intraoperative, and postoperative periods including restricted versus liberal or goal-directed approaches using fluid biomarkers. Enhanced Recovery After Surgery (ERAS) protocols emphasize individualized fluid plans guided by physiologic targets as part of multimodal care.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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- 1. Fluid Management in Resuscitation Muhammad Tsaqolain Pai 16 May 2024 Bilik Seminar
- 2. Topics • Introduction • Indication • Phases of Fluid Resuscitation • Assessment of Hydration • Types of Fluid in Resuscitation
- 3. Introduction • Treat fluid as drug (know 4D) • Need to know when to give • Take account of patient’s condition • Treatment should be individualized • Risk and benefit of fluid to patient
- 4. 4 D’s of Fluid DE-ESCALATION DRUG DOSAGE DURATION
- 5. Indication For Intravenous Fluid 1) Resuscitation : To correct an intravascular volume deficit 2) Maintenance: to cover the patient’s daily basal requirements of water, glucose and electrolytes. 3) Replacement Fluid: to correct fluid deficits that cannot be compensated by oral intake 4) Nutrition Fluid
- 6. Too Low vs Too Much Too low (Restrictive) - Cause underhydration - lead to ischemia, irreversible injury, AKI Too Much - Cause Overhydration - Leads to edema, hypoxia, overload, fluid creep , irreversible injuries
- 7. Phases of Fluid Therapy (ROSE)
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- 10. • Advanced ( Goal Directed) - More precise - Evaluate cardiac output response to preload (fluid responsiveness) - Echocardiography - Lactate : for hyperlactinemia, signs of hypoperfusion
- 13. Types of Fluid in Resuscitation
- 14. Types of Fluid Crystalloid • Non Balanced Crystalloid : Normal Saline • Balanced Crystalloid : Hartmann, Ringer’s, Sterofundin • Isotonic Sodium Bicarbonate 1.3% • Isotonic Sodium Bicarbonate 4.2% Colloid • Gelatin • Hydroxyethyl Starch (HES) • Human Albumin
- 15. Crystalloid as 1st line of Fluid in Resuscitation • Why? - Low viscosity - Venodilator - Provides high flow rate
- 17. Explain what is hyperchloremic met acidosis and how it helps in lossess?
- 19. *MAKE30 : Major Adverse Kidney Events by 30 days
- 32. NAGMA VS HAGMA Anion Gap = Na + K ]- [ Cl+HCO3 ] Normal Range : 8-16mmol/L HYPERCHLOREMIA (Decreased HCO3 compensated by Chloride) NORMOCHLOREMIA ( Increased organic acids )
- 33. Take Home Message • Treat fluid as a drug ( 4D) • Start resuscitation with crystalloid • Use balanced crystalloid in anticipation of > 2L: septic shock, DKA, dengue • Isotonic NaHCO3 reduces mortality in NAGMA, AKI patients • Human albumin reduces mortality in septic patients • Avoid gelatin and HES in septic patients • Adopt restrictive fluid strategy • Administer fluid according to ROSE, different fluid balance at different phase
- 34. Thank You