Fluid and electrolytes management in post op patientsDr.Sonal Dixit
sonal dixit , mbbs , ms obg
After surgery modification in normal physiology of fluid and electrolytes balance.
- ACUTE STRESS leads to increased sympathetic stimuli- tachycardia, vasoconstriction & stress.
Increased ACTH stimulate adrenal gland which secretes large amount of hydrocortisone to fight acute stress and aldosterone which leads to Na retension and urinary loss of K.
its sometime difficult to decide in urgent clinical scenarios - Trauma,active bleeding, surgery: What ; when ; how and why to transfuse? answering some of these queries here is my presentation especially made for PG students (will help in answer writing)
Professor Mridul M. Panditrao, deals with this basic, complicated but very important topic for not only post- graduates but also for under-graduates. Various complicated issues have been discussed in detail, mainly from clinical point of view.
Fluid and electrolytes management in post op patientsDr.Sonal Dixit
sonal dixit , mbbs , ms obg
After surgery modification in normal physiology of fluid and electrolytes balance.
- ACUTE STRESS leads to increased sympathetic stimuli- tachycardia, vasoconstriction & stress.
Increased ACTH stimulate adrenal gland which secretes large amount of hydrocortisone to fight acute stress and aldosterone which leads to Na retension and urinary loss of K.
its sometime difficult to decide in urgent clinical scenarios - Trauma,active bleeding, surgery: What ; when ; how and why to transfuse? answering some of these queries here is my presentation especially made for PG students (will help in answer writing)
Professor Mridul M. Panditrao, deals with this basic, complicated but very important topic for not only post- graduates but also for under-graduates. Various complicated issues have been discussed in detail, mainly from clinical point of view.
Fluid Therapy is the administration of fluids to a patient as a treatment or preventative measure. It can be administered via an intravenous, intraperitoneal, intraosseous, subcutaneous and oral routes. 60% of total bodyweight is accounted for by the total body water.
Different fluids can be
cyrstalloids, colloids, hypertonic saline, hypotonic saline, ringer lactate.
Personal Brand Statement:
As an Army veteran dedicated to lifelong learning, I bring a disciplined, strategic mindset to my pursuits. I am constantly expanding my knowledge to innovate and lead effectively. My journey is driven by a commitment to excellence, and to make a meaningful impact in the world.
Business Valuation Principles for EntrepreneursBen Wann
This insightful presentation is designed to equip entrepreneurs with the essential knowledge and tools needed to accurately value their businesses. Understanding business valuation is crucial for making informed decisions, whether you're seeking investment, planning to sell, or simply want to gauge your company's worth.
RMD24 | Debunking the non-endemic revenue myth Marvin Vacquier Droop | First ...BBPMedia1
Marvin neemt je in deze presentatie mee in de voordelen van non-endemic advertising op retail media netwerken. Hij brengt ook de uitdagingen in beeld die de markt op dit moment heeft op het gebied van retail media voor niet-leveranciers.
Retail media wordt gezien als het nieuwe advertising-medium en ook mediabureaus richten massaal retail media-afdelingen op. Merken die niet in de betreffende winkel liggen staan ook nog niet in de rij om op de retail media netwerken te adverteren. Marvin belicht de uitdagingen die er zijn om echt aansluiting te vinden op die markt van non-endemic advertising.
Memorandum Of Association Constitution of Company.pptseri bangash
www.seribangash.com
A Memorandum of Association (MOA) is a legal document that outlines the fundamental principles and objectives upon which a company operates. It serves as the company's charter or constitution and defines the scope of its activities. Here's a detailed note on the MOA:
Contents of Memorandum of Association:
Name Clause: This clause states the name of the company, which should end with words like "Limited" or "Ltd." for a public limited company and "Private Limited" or "Pvt. Ltd." for a private limited company.
https://seribangash.com/article-of-association-is-legal-doc-of-company/
Registered Office Clause: It specifies the location where the company's registered office is situated. This office is where all official communications and notices are sent.
Objective Clause: This clause delineates the main objectives for which the company is formed. It's important to define these objectives clearly, as the company cannot undertake activities beyond those mentioned in this clause.
www.seribangash.com
Liability Clause: It outlines the extent of liability of the company's members. In the case of companies limited by shares, the liability of members is limited to the amount unpaid on their shares. For companies limited by guarantee, members' liability is limited to the amount they undertake to contribute if the company is wound up.
https://seribangash.com/promotors-is-person-conceived-formation-company/
Capital Clause: This clause specifies the authorized capital of the company, i.e., the maximum amount of share capital the company is authorized to issue. It also mentions the division of this capital into shares and their respective nominal value.
Association Clause: It simply states that the subscribers wish to form a company and agree to become members of it, in accordance with the terms of the MOA.
Importance of Memorandum of Association:
Legal Requirement: The MOA is a legal requirement for the formation of a company. It must be filed with the Registrar of Companies during the incorporation process.
Constitutional Document: It serves as the company's constitutional document, defining its scope, powers, and limitations.
Protection of Members: It protects the interests of the company's members by clearly defining the objectives and limiting their liability.
External Communication: It provides clarity to external parties, such as investors, creditors, and regulatory authorities, regarding the company's objectives and powers.
https://seribangash.com/difference-public-and-private-company-law/
Binding Authority: The company and its members are bound by the provisions of the MOA. Any action taken beyond its scope may be considered ultra vires (beyond the powers) of the company and therefore void.
Amendment of MOA:
While the MOA lays down the company's fundamental principles, it is not entirely immutable. It can be amended, but only under specific circumstances and in compliance with legal procedures. Amendments typically require shareholder
What are the main advantages of using HR recruiter services.pdfHumanResourceDimensi1
HR recruiter services offer top talents to companies according to their specific needs. They handle all recruitment tasks from job posting to onboarding and help companies concentrate on their business growth. With their expertise and years of experience, they streamline the hiring process and save time and resources for the company.
The world of search engine optimization (SEO) is buzzing with discussions after Google confirmed that around 2,500 leaked internal documents related to its Search feature are indeed authentic. The revelation has sparked significant concerns within the SEO community. The leaked documents were initially reported by SEO experts Rand Fishkin and Mike King, igniting widespread analysis and discourse. For More Info:- https://news.arihantwebtech.com/search-disrupted-googles-leaked-documents-rock-the-seo-world/
Discover the innovative and creative projects that highlight my journey throu...dylandmeas
Discover the innovative and creative projects that highlight my journey through Full Sail University. Below, you’ll find a collection of my work showcasing my skills and expertise in digital marketing, event planning, and media production.
Putting the SPARK into Virtual Training.pptxCynthia Clay
This 60-minute webinar, sponsored by Adobe, was delivered for the Training Mag Network. It explored the five elements of SPARK: Storytelling, Purpose, Action, Relationships, and Kudos. Knowing how to tell a well-structured story is key to building long-term memory. Stating a clear purpose that doesn't take away from the discovery learning process is critical. Ensuring that people move from theory to practical application is imperative. Creating strong social learning is the key to commitment and engagement. Validating and affirming participants' comments is the way to create a positive learning environment.
Attending a job Interview for B1 and B2 Englsih learnersErika906060
It is a sample of an interview for a business english class for pre-intermediate and intermediate english students with emphasis on the speking ability.
As a business owner in Delaware, staying on top of your tax obligations is paramount, especially with the annual deadline for Delaware Franchise Tax looming on March 1. One such obligation is the annual Delaware Franchise Tax, which serves as a crucial requirement for maintaining your company’s legal standing within the state. While the prospect of handling tax matters may seem daunting, rest assured that the process can be straightforward with the right guidance. In this comprehensive guide, we’ll walk you through the steps of filing your Delaware Franchise Tax and provide insights to help you navigate the process effectively.
Cracking the Workplace Discipline Code Main.pptxWorkforce Group
Cultivating and maintaining discipline within teams is a critical differentiator for successful organisations.
Forward-thinking leaders and business managers understand the impact that discipline has on organisational success. A disciplined workforce operates with clarity, focus, and a shared understanding of expectations, ultimately driving better results, optimising productivity, and facilitating seamless collaboration.
Although discipline is not a one-size-fits-all approach, it can help create a work environment that encourages personal growth and accountability rather than solely relying on punitive measures.
In this deck, you will learn the significance of workplace discipline for organisational success. You’ll also learn
• Four (4) workplace discipline methods you should consider
• The best and most practical approach to implementing workplace discipline.
• Three (3) key tips to maintain a disciplined workplace.
2. Nomenclature of solutionsNomenclature of solutions
• One mole of substance = 6.02 x 1023
molecules
• Molarity = no. of moles of solute
L of solution
• Molality = no. of moles of solute
kg of solvent
3. • Equivalency = substance that ionize
• The no. of equivalents of an ion in a solution is
the no. of moles x by its charge (VALENCE)
• Tonicity – refers to the effect a solution has on
cell volume
• Isotonic – no effect
• Hypotonic – inc. cell volume
• Hypertonic – dec. cel volume
5. Intracellular fluidIntracellular fluid
• Outer membrane of the cell – regulates
intracellular volume and composition
• Membrane bound ATP dependent pump
• Na : K ( 3:2 ) ratio
• Impermeable to Na, lesser extent K
• Na – most important determinant of ECOP
• K - ICOP
• High intracellular protein concentration
(impermeable)
7. Swelling of cellsSwelling of cells
• Interference with Na-K ATPase activity
• Occurs during hypoxia and ischemia
8. Extracellular fluidExtracellular fluid
• Provide cells with nutrients , remove their
waste products
• Na – major determinant of ECFV ,ECOP
• Na intake , renal Na excretion, extrarenal
Na losses
9. Interstitial fluidInterstitial fluid
• -5 mmhg
• Edema
• Low protein content ( 2 g/dl )
• Lymphatics
• Overflow reservoir for the intravascular
compartment
10. Intravascular fluidIntravascular fluid
• Plasma
• Most electrolytes (small ions ) freely pass
between plasma and interstitium
• Tight intercellular junction between
endothelial cells
• Impede passage of plasma proteins
• Albumin – osmotically active solute in fluid
exhange
12. Exchange between fluidExchange between fluid
compartmentscompartments
• Diffusion – random movement of
molecules due to their kinetic energy
• Rate of diffusion depends on :
• 1. permeability of that substance
• 2. concentration gradient
• 3. pressure difference
• 4. electrical potential across the
membrane
13. Diffusion Through CMDiffusion Through CM
• Directly through the bilipid layer
• Protein channels
• Reversible binding through carrier protein
(fascilitated diffusion)
14. Penetrate the CM directlyPenetrate the CM directly
• Water
• Oxygen
• Carbon dioxide
• Lipid soluble molecules
15. Penetrate poorly the CMPenetrate poorly the CM
• Cations wjth transmembrane voltage
potential (positive to the outside)
• Na
• K
• Ca
• *diffuse through specified protein channels
• *ligands (acetylcholine) to the membrane
receptors
16. • Glucose and Amino acids diffuse with the
help of membrane bound carrier proteins
17. Fluid exchangeFluid exchange
• Difference in non diffusable solute
concentration will lead to fluid exchange
between the IC and Interstitium which is
governed by osmotic forces.
• Net water movement – hypo to
hyperosmolar compartment
18. Diffusion through capillaryDiffusion through capillary
endotheliumendothelium
• Oxygen, CO2, H2O, lipid soluble
substance
• Low molecular weight water soluble
substances ( Na, Cl, K, glucose )
19. • High molecular weight substances
• Plasma proteins – penetrate endothelial
clefts poorly except liver and lungs (larger
clefts)
20. Fluid exchange across capillariesFluid exchange across capillaries
• Differences in :
• Hydrostatic pressure
• Osmotic pressure
21.
22. Body Fluid compartments (based on average 70 kg male)
Compartment Body weight (%) Total Body Water
(%)
Volume (L)
Intracellular 36 60 25
Extracellular
Interstitial 19 32 13.5
Intravascular 5 8 3.5
Total 60 100 42
24. Normal Water Balance
Normal adult daily water intake 2500ml
Normal water loss 2500ml
Urine 1500ml
Resp tract eva 400ml
Skin evaporation 400ml
Sweat 100ml
Feces 100ml
25. Total Blood Volume(TBV) = RBC volume + plasma volume
2L + 3L = 5L
7% of body weight
ETBV = 4.9L
26. Hyperosmolarity and Hypernatremia
- total body solute increases relative to TBW
- Na > 145 meq/L
- Loss of water in excess of sodium (hypotonic fluid loss)
- Retention of large amounts of sodium
- Compute for the water deficit
27. Ex. A 70kg man is found to have a plasma sodium of 160meq/L
What is his water deficit?
( Normal TBW ) ( 140 ) = ( present TBW ) ( plasma Na )
(70) (0.6) ( 140 ) = ( present TBW ) ( 160)
Present TBW = 36.7L
Water deficit = NormalTBW – Present TBW
42L – 36.7L
= 5.3L
30. Ex. An 80kg woman is lethargic and is found to have a plasma sodium of
118meq/L. How much NaCl must be given to raise her plasma sodium to
130 meq/L.
Sodium Deficit = ( TBW ) ( 130 – 118 )
= ( 80 ) ( 0.5 ) ( 12 )
= 480 meq
Normal isotonic saline = 154 meq/L
= 3.12 L of normal saline
31. Intravenous fluids
Crystalloids
- aqueous solutions of low molecular wt., w/ or w/out glucose.
- Ratio is 3:1
- Maintains intravascular volume
-Excessive amounts of fluid will manifest as peripheral edema
-before it ges into the lungs.
32. Types of solutions:
maintenance solutions – primarily due to water loss
-replaced by hypotonic solutions
replacement solutions – losses that involve water and electrolytes
- replaced with isotonic electrolye solutions.
33. Colloids
-contains high molecular wt. substances such as proteins or large
glucose polymers
-5% dextran, starch solutions.
-normal ratio is 1:1 when used as a replacement in cases of blood loss
-maintains intravascular volume by increasing the oncotic pressure
-should be given slowly and in small amounts to prevent pulmonary
edema
34. Estimating Maintenance Fluid Reqiurements
Weight Rate
For the first 10 kg 4 ml/ kg / hr
For the next 10-20 kg add 2ml / kg /hr
For each kg above 20 kg add 1 ml /kg /hr
35. Ex. MFR for a 25 kg child
?
40 + 20 + 5 =65 ml/hr
41. Allowable Blood Loss
Based on hemoglobin level
= (EBV) (initial Hgb – targeted Hgb)
initial Hgb
Ex. Compute for the ABL of a 70 kg male patient with an initial
Hgb of 15gms% And a targeted Hgb of 10 gms%.
= (75) (70) (15 – 10)
15
= 1750 ml.
42. Based on hematocrit
=Ex. What is the ABL of an 85 kg female patient with a pre-op Hct of
35% and a post Op Hct of 30%.
Hct = ( RBCV lost ) ( 3 )
RBCV 35% = ( EBV ) (0.35) = 1934
RBCV 30% = ( 5525 ) (0.30) = - 1657
RBCV lost = 277
ABL = ( 227 ) ( 3 ) = 831 ml
45. Essential monitors for all patients undergoing ansthesia
observation
auscultation
pulse oximeter
capnograph
ECG
46. The secret of life is not just to liveThe secret of life is not just to live
but to have something worthwhilebut to have something worthwhile
to live for.to live for.
