- IV fluids can be either beneficial or harmful depending on how they are administered. The optimal volume and type of fluid needs to be determined based on the individual patient's condition, fluid losses, and volume status. While crystalloids are generally preferred over colloids, aggressive fluid resuscitation is important for conditions like burns, trauma, and sepsis. Close monitoring of fluid administration and outcomes is essential to avoid under- or over-hydration.
This PPT gives an idea to MBBS students about the Type of fluids, Calculating the daily requirements as well as the drop rate to be used in day today clinical practice.
Brief review of basic human fluid physiology, different types of fluids used in different clinical settings specially in surgical patients. Very useful for all medical students.
Common fluids used in anaesthesia and fluid therapyArowojolu Samuel
common fluids used in anaesthesia. fluid therapy in anaesthesia and theatre. emergency fluid replacement. calculation of fluid by anaesthetist. colloids and crystalloids, indication in anaesthesia
This PPT gives an idea to MBBS students about the Type of fluids, Calculating the daily requirements as well as the drop rate to be used in day today clinical practice.
Brief review of basic human fluid physiology, different types of fluids used in different clinical settings specially in surgical patients. Very useful for all medical students.
Common fluids used in anaesthesia and fluid therapyArowojolu Samuel
common fluids used in anaesthesia. fluid therapy in anaesthesia and theatre. emergency fluid replacement. calculation of fluid by anaesthetist. colloids and crystalloids, indication in anaesthesia
This slide share includes definition,indications,dehydration status,types of fluids,when to administer which fluid,how to calculate the fluid to be administered and how to monitor fluid therapy.Hope its helpful.
Iv fluid therapy (types, indications, doses calculation)kholeif
All what you need to know intravenous fluids, types, indications, contraindications, how to calculate fluid rate and drug dosages.
Embed code (http://www.slideshare.net/slideshow/embed_code/16138690)
Is there evidence for any fluid therapy in the critically ill? Anders Perner ...scanFOAM
A talk by Anders Perner at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
All conference content listed here: https://scanfoam.org/ssai2017/
Understand principles of fluids, fluid compartments and composition
Identify role of kidneys in fluid management
Establishing Target Weight
Understand consequences of fluid overload
Assessing and implementing successful fluid overload management practices according to guidelines
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
How to Give Better Lectures: Some Tips for Doctors
Fluid management
1. B Y : D R I S M A H
S U R G I C A L D E P A R T M E N T
IV FLUIDS
beneficial or more harm?
1
2. MAIN REFERENCE
FLUID MANAGEMENT 2013 Elsevier Ltd. by
• Claire Leech BSc MBBS FRCA
Specialist Registrar in Anaesthesia & Critical Care, Northern Deanery,
UK.
• Ian D Nesbitt MBBS FRCA DICM(UK) FFICM
Consultant in Anaesthesia & Critical Care at the Freeman Hospital,
Newcastle upon Tyne, UK.
2
3. CONTENTS
• Fluid compartments in the body
• Normal requirements
• Types of IV fluids and choice of fluid
• Common issues in fluid management of surgical patients
• Fluids issues in burn, trauma & sepsis
3
6. NORMAL REQUIREMENTS
• Water 35 ml/kg or 2.5 L/day for 70 kg male
-fluid losses 1.5L by urine & feces
1.0L by respiration/skin
*fever – 10% increase in water losses for every degree temperature
rise above 38C
• Na+ : 1-1.5 mmol/kg/day
• K+ : 1 mmol/kg/day
6
7. When considering a fluid strategy for a patient the
following should be considered:
• The patient’s normal requirements
• Current volume status; the perioperative patient is often fluid
deplete requiring a period of ‘catch up’
• Electrolyte status
• On going excessive losses (e.g. high output fistula, high gastric
losses, third space losses). Examples such as these may also
require consideration of electrolyte supplementation at a different
amount to the above
• Excessive fluid intake (e.g. drug infusions or antibiotics)
7
10. CRYSTALLOIDS OR COLLOIDS?
10
Crystalloids Colloids
Advantages Disadvantages Advantages Disadvantages
• Cheap
• Non allergic
• No transmission
of infection
• No interference
with coagulation
• Higher volume
needed
• Relatively short
amount of time
remaining
intravascularly
• Expansion
plasma volume
far superior
• May be salt
sparing
• Expensive
• Risk of allergy
• Coagulopathy
• Itch
• May exacerbate
tissue edema
*The cost of each life saved using crystalloids is $45.13, and the cost of each life saved using colloidal
solutions is $1493.60 - http://www.ncbi.nlm.nih.gov/pubmed/2010737
11. A. PREOPERATIVE
• Pt who undergo major surgery in dehydrated state have worst outcome
• Aim is to maintain tissue perfusion and O2 delivery
• Bowel preparation & fasting pre op can lead to dehydration
• Recommended suitable fasting time by The Association of Anesthetist of the Great Britain and
Ireland
- 6 hrs for solid food/milk
- 2 hrs for clear fluid
• Growing evidence that bowel preparation is unnecessary
- Advocate supplying pt with carbohydrate drink the night before/morning of
surgery to prevent fluid/electrolytes disturbance
11
12. B. PERIOPERATIVE
• Both surgery and anesthesia affect fluid balance
- Anesthesia causes vasodilation
- Surgery cause hemorrhage, 3rd space losses and evaporative
losses
• However, excessive IV fluids can cause many complications as
inadequate administration of fluids
• The administration of fluid should be done to maintain the cardiac
output (goal directed therapy) at optimum level to reduce hospital
stay and morbidities
- Used of additional monitoring measure is often used; including the
oesophageal doppler, pulmonary artery catheter, and pulse contour
analysis monitors
12
13. C. POSTOPERATIVE
• Management includes the administration of maintenance
fluids plus replacement of on going losses.
• Close monitoring of electrolytes should be done in
addition to this.
• Intravenous fluids should be discontinued as soon
as the patient is able to tolerate oral fluids.
13
14. A. BURN
• Fluid resus is very important especially for pt with burn of >
10-15% BSA
• Damage of skin cause significant fluid loss
• Parkland formula
(%BSA burn X wt X 4ml)/24 hrs
- Half in 1st 8 hrs and half in 16 hrs
- Fluid of choice: Hartmann’s
• Aim: minimum urine output 0.5ml/kg/hr
• Rise of serum lactate may indicate more fluid required
14
15. B. TRAUMA
• For major trauma as per advanced trauma life support
protocols;
- 2L of warmed Hartmann’s followed by assessment of
response
- Early aggressive correction of acute coagulopathy
using blood and products
15
16. C. SEPSIS
• Volume deficit due to combination of
- Vasodilation
- Capillary leak
- Insensible losses
• Need for aggressive fluid replacement, particularly in 1st
24hrs
16
17. 17
• Volume
- The optimal volume of resuscitative fluid is unknown.
- As examples, two studies of early goal directed therapy
reported mean infusion volumes that ranged from 3 to 5 litersRivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345:1368, & ProCESS Investigators, Yealy DM, Kellum JA, et al. A randomized trial of
protocol-based care for early septic shock. N Engl J Med 2014; 370:1683.
- The volume of fluid that was administered within the initial six
hours of presentation was targeted to set physiologic
endpoints (e.g., mean arterial pressure)
- Thus, rapid, large volume infusions of intravenous fluids are
indicated as initial therapy for severe sepsis or septic shock,
unless there is coexisting clinical or radiographic evidence of
heart failure.
- Fluid therapy should be administered in well-defined (e.g.,
500 mL), rapidly infused boluses Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines
for management of severe sepsis and septic shock: 2012. Crit Care Med 2013; 41:580.
18. 18
• Choice of fluid
A. Crystalloid versus albumin:
In the Saline versus Albumin Fluid Evaluation (SAFE) trial, 6997 critically ill
patients were randomly assigned to receive 4 percent albumin solution or
normal saline for up to 28 days [24]. There were no differences between
groups for any endpoint, including the primary endpoint, mortality.
Among the patients with severe sepsis (18 percent of the total group), there
were also no differences in outcome. In another multicenter open-label
randomized trial of patients with severe sepsis or septic shock, the addition
of albumin to crystalloid did not improve survival compared to
crystalloid alone (31 versus 32 percent) [25].
B. Crystalloid versus hydroxyethyl starch:
In the Scandinavian Starch for Severe Sepsis and Septic Shock (6S) trial, 804
patients with severe sepsis were randomly assigned to receive either 6
percent hydroxyethyl starch or Ringer’s acetate at a volume of up to
33 mL/kg of ideal body weight per day [26]. When assessed 90 days after
randomization, mortality was increased in the hydroxyethyl starch group
(51 versus 43 percent) and more patients in the hydroxyethyl starch
group had required renal replacement therapy at some time during their
illness (22 versus 16 percent).
19. CONCLUSION
• Normal requirement of body
- Water 35 ml/kg or 2.5 L/day for 70 kg male
- Na+ : 1-1.5 mmol/kg/day
- K+ : 1 mmol/kg/day
• Fluid therapy strategy should be individualized
• Crystalloids are more beneficial often used than colloids in
most conditions
• Beware to not give inadequate or excessive fluid therapy –
goal directed therapy
19