Fluid Therapy PDF

FLUID THERAPY  REVIEW THE PRESENTATION FLUID THERAPY ON THE BRIGHTSPACE PAGE. WATCH THE FOLLOWING VIDEO ON CRYSTALLOID AND COLLOID FLUIDS: IV FLUIDS: CRYSTALLOIDS AND COLLOIDS (20:16) WATCH THE FOLLOWING V...

FLUID THERAPY  REVIEW THE PRESENTATION FLUID THERAPY ON THE BRIGHTSPACE PAGE. WATCH THE FOLLOWING VIDEO ON CRYSTALLOID AND COLLOID FLUIDS: IV FLUIDS: CRYSTALLOIDS AND COLLOIDS (20:16) WATCH THE FOLLOWING VIDEO ON BLOOD AND BLOOD PRODUCTS: BLOOD PRODUCTS (13:53) REQUIREMEN REVIEW OSMOSIS AND TONICITY BY WATCHING THE FOLLOWING TS VIDEOS BY KHAN ACADEMY (ELECTIVE): OSMOSIS>MEMBRANES AND TRANSPORT (8:03) HYPOTONIC, ISOTONIC, AND HYPERTONIC SOLUTIONS (TONICITY ) (6:29) WATCH THE FOLLOWING VIDEO ON HYDROSTATIC AND ONCOTIC PRESSURE (ELECTIVE): HYDROSTATIC AND OSMOTIC PRESSURE (6:21) YOU MAY CHOOSE TO REVIEW ABO BLOOD TYPING HERE (ELECTIVE): WHY DO BLOOD TYPES MATTER? (4:41)  DISCUSS THE FUNCTIONS OF WATER IN THE BODY. DESCRIBE THE WAYS THAT WATER MOVES WITHIN THE BODY. EXPLAIN DIFFUSION, OSMOSIS, OSMOTIC PRESSURE, ONCOTIC PRESSURE, HYDROSTATIC PRESSURE. PROVIDE DETAIL ON BODY FLUID COMPARTMENTS AND FLUID COMPOSITION. IDENTIFY THE TONICITY OF A SOLUTION AND ITS EFFECTS ON CELLS OBJECTIV AND FLUID MOVEMENT. LIST AND DIFFERENTIATE VARIOUS CRYSTALLOID FLUIDS YOU MAY ES ENCOUNTER. DISCUSS THE INDICATIONS, CONTRAINDICATIONS, PRECAUTIONS, DOSE, AND ADVERSE EFFECTS OF ADMINISTERING CRYSTALLOID FLUIDS. DISCUSS THE INDICATIONS, CONTRAINDICATIONS, PRECAUTIONS, DOSE, AND ADVERSE EFFECTS OF ADMINISTERING COLLOID FLUIDS. LIST AND DIFFERENTIATE THE DIFFERENT BLOOD AND BLOOD PRODUCTS YOU MAY ENCOUNTER. PROVIDE INDICATIONS FOR THEIR USE. DISCUSS TRANSFUSION-RELATED REACTIONS.  Building of cell protoplasm. Protection and lubrication of body tissues. FUNCTIO NS OF Component of osmoregulation and homeostasis. WATER IN THE BODY Transport medium for blood and immune cells, nutrients, hormones and chemical messengers, and waste products. Regulation of body temperature.  PRINCIPAL OF MACROSCOPIC ELECTRONEUTRALITY Membranes between compartments are selectively Positive and negative permeable, allowing free charges within a movement of small ions but compartment balance out restrict the movement so that there is no net of large particles such as charge. proteins. This results in a concentration gradient of an ion across a membrane while maintaining electroneutrality.  WATER AND SOLUTE MOVEMENT Active Diffusion Osmosis transport WATER MOVEMENT- DIFFUSION DIFFUSION: PROCESS RES ULTING FROM RANDOM MOTION OF MOLECULES BY WHICH THERE IS A NET FLOW OF PARTICLES FROM A REGION OF HIGH CONCENTRATION TO A REGION OF LOW CONCENTRATION.  WATER MOVEMENT- OSMOSIS OSMOSIS: THE SPONTA NEOUSPASSAGE OR DIFFUSION OF WATER THROUGH A SEMIPERME ABLE MEMBRANE  OSMOTIC PRESSURE THE PRESSURE THAT MUST BE APPLIED TO A SOLUTION TO STOP THE FLOW OF WATER ACROSS A SEMIPERMEABLE MEMBRANE. HYDROSTATIC PRESSURE: THE PRESSURE EXERTED BY A SOLUTION AT EQUILIBRIUM ONCOTIC PRESSURE: PROTEINS UNABLE TO CROSS COMPARTMENT MEMBRANES DRAW WATER FROM EXTERNAL COMPARTMENTS INTERSTITI AL EDEMA BODY FLUID COMPARTM ENTS TOTAL BODY FLUID (TBF) 50-60% BODY MASS IN ADULTS 60-80% BODY MASS IN NEONATES/PEDIATRICS INTRACELLULAR FLUID (ICF) 2/3 TBF EXTRACELLULAR FLUID (ECF) 1/3 TBF FURTHER DIVIDED INTO INTERSTITIAL FLUID, 80% ECF PLASMA, 20% ECF  FLUID COMPOSITION Intracellu Extracellul lar ar Anion Cation Anion Cation Potassiu Magnesiu Bicarbona Proteins ATP Chloride Proteins Sodium m m te TONICITY  FLUID ADMINISTRATION  INCREASE PERFUSION TO ORGANS AND TISSUES BY INCREASING BLOOD VOLUME.​ SHOCK BURNS SEVERE DEHYDRATION FLUID CRYSTALLOID VS COLLOID FLUIDS​VS BLOOD AND BLOOD PRODUCTS. ADMINISTRATI THINGS TO CONSIDER:​ ON GOALS IV SITE AND GAUGE​ FLUID TYPE, FLOW RATE, VOLUME TO BE DELIVERED​ TOTAL BODY FLUID VOLUME AND INTRAVASCULAR VOLUME​ O2 AND CLOTTING IMPAIRMENT CRYSTALLOIDS  CRYSTALLOID FLUIDS 0.9%, 0.45%, 3%, Closer to plasma pH, D5W, D10W, D5NS, Sodium Ringer’s chloride Lactate Dextrose 7.5% NaCl​ contains a lactate buffer​ D5+0.45NS​ Causes Contains Ca ​ Physiologically hypotonic a hyperchloremic acidosi Continuous infusion is due to rapid uptake of s​ incompatible with some dextrose​ High sodium load​ drugs​ Not a resuscitation fluid​ Drug and fluid pH: 6.5​ Incompatible with several compatibility​ Osm: 273​ drugs pH: 5.5​ Na: 130​ pH 3.5-6.5​ Osm: 308​ Cl: 109​ Osm 252​ Na: 154​ K: 4​ No electrolytes​ Cl: 154 Ca: 3​ Lactate: 28​  CRYSTALLOID INFUSIONS Overview Indications Fluids that supply water and Hypovolemia: Better for replacing electrolytes losses rather than expanding Help to maintain osmotic gradient plasma volume. between extravascular and Used as maintenance fluids: intravascular compartments Compensate for insensible fluid Plasma-volume expanders due to losses sodium concentrations To replace fluids Do not contain proteins (colloids) To manage specific fluid and Contain fluids and electrolytes that electrolyte disturbances are normally found in the body Promote urinary flow Distribution = 2/3 extravascular, 1/3 To keep IV catheters patent when intravascular not in use.  CRYSTALLOID INFUSIONS Contraindications Precautions Crystalloid boluses Use with caution in patients should not be with heart failure, renal administered when failure, and severe electrolyte disturbances. there is evidence of fluid Only give as a last resort in overload or severe left hemorrhagic shock ventricular dysfunction. In cases where large amounts of fluids may have to be administered, it might be prudent to use lactated Ringer’s solution  CRYSTALLOID INFUSIONS How supplied Dose Adverse effects Supplied in 50, TKVO May cause 100, 250, 500, and Adult: 75 mL/h pulmonary, 1000 mL bags. Maintenance cerebral, or Sterile saline for 4-2-1 rule peripheral edema irrigation should Will dilute plasma Bolus not be confused 10 or 20 proteins (↓COP, with that designed ↓Hct, ↓clotting for intravenous mL/kg/dose factors). administration. depending on May worsen situation acidosis. May cause/worsen hypothermia. HYPERTONIC SALINE HAVE CONCENTRATIONS GREATER THAN ISOTONIC CONCENTRATION OF 0.9% TYPICAL SOLUTIONS ARE 3%, 5%, OR 7% SALINE 3 TO 5X HIGHER SODIUM CONCENTRATION THAN STANDARD NORMAL SALINE HIGHER CONCENTRATION OF SODIUM PULLS MORE VOLUME INTO VASCULAR SPACE SOME SOLUTIONS USE PARTICLES OTHER THAN SODIUM TO MAKE HYPERTONIC FLUID NEARPOD QUESTION 1  NEARPOD QUESTION 1 YOUR PATIENT HAS A VERY LOW BLOOD PRESSURE SECONDARY TO A GASTROINTESTINAL ILLNESS. DISCUSS THE THINGS YOU WILL LOOK FOR IN YOUR PHYSICAL EXAM, INCIDENT HISTORY, AND MEDICAL HISTORY, THAT WILL GUIDE YOUR CHOICE OF FLUID AND VOLUME. COLLOIDS COLLOIDS REMAINS INTRAVASCULAR (ASSUMING INTACT VESSEL MEMBRANES)​ MAY DRAW FLUID FROM EXTRAVASCULAR SPACE​ CONTAINS NO ELECTROLYTES​ PH ALBUMIN: 7.4​ IS CONSIDERED A BLOOD PRODUCT SO TRANSFUSION CONSENT MUST BE OBTAINED​ ALBUMIN: 5% SOLUTION IS ISO- ONCOTIC AND LEADS TO 80% INITIAL VOLUME EXPANSION WHEREAS 25% SOLUTION IS HYPER-ONCOTIC AND LEADS TO 200 - 400% INCREASE IN VOLUME WITHIN 30 MINUTES. THE EFFECT PERSISTS FOR 16 - 24 H.  COLLOIDS Indications Contraindications Precautions Draw excess Allergy Albumin is a extravascular CHF with blood product fluid into the evidence of Use with caution intravascular volume overload in patients with space. cardiac and renal Replace low disease. albumin. May leak into the May be used in interstitium in various shock cases of states but new increased evidence shows vascular no benefit over permeability crystalloid in No O2 carrying initial capacity. ADVERSE EFFECTS ALBUMIN: ANAPHYLAXIS OR ANAPHYLACTOID REACTION INFECTION FLUID OVERLOAD, EDEMA IMPAIRED COAGULATION STARCHES ANAPHYLAXIS RENAL DYSFUNCTION IMPAIRED COAGULATION FLUID OVERLOAD, EDEMA BLOOD AND BLOOD PRODUCTS  BLOOD AND BLOOD PRODUCTS COLLOID BLOOD PRODUCTS ARE CONSIDERED A HUMAN TISSUE TRANSPLANT…CONSENT IS REQUIRED!​ PACKED RED BLOOD CELLS (PRBC), FRESH FROZEN PLASMA (FFP), PLATELETS, CRYOPRECIPITATE, PROTHROMBIN COMPLEX CON CENTRATES (PCC)​ THINGS TO CONSIDER:​ VASCULAR ACCESS​ SPECIAL FILTERS, TUBING, AND HANDLING.​ EACH REQUIRE A SEPARATE IV AND ARE INCOMPATIBLE WITH MEDICATIONS.​ CROSS-MATCHED VS UNCROSS-MATCHED​  BLOOD AND BLOOD PRODUCTS Contain red blood Contains acellular bl Contains platelets in Platelets PRBC FFP cells ood components small amount and 20% plasma.​ (albumin, of plasma.​ 200-400 ml/unit​ clotting factors, 50 ml/unit, 4-6 Expected Hgb incre fibrinogen, prothro units/dose​ ase of 10 g/L for mbin)​ Stored at each unit infused.​ 250 ml/unit, 4-6 room temperature​ Refrigerated produc unit/dose​ Complex ABO t​ Frozen product, and Rh typing (cellu ABO and Rh specific​ requires re-warming lar vs plasma). Massive prior to use​ Labeled as ABO transfusion protocol ABO specific​ identical or non- 1:1:1 or 2:1:1​ Massive transfusion identical. ​ Treatment protocol 1:1:1 or Massive transfusion of anemia​ 2:1:1​ protocol 1:1:1 or Replace clotting 2:1:1​ factors Treat thrombocytop  BLOOD AND BLOOD PRODUCTS Made from FFP. Prothrombin Complex Freeze-dried FFP Other Cryoprecipita PCC te Contains fibrinogen, Concentrates Easy to store (room Factor VIII, Factor XIII, Factors II, VII, IX, X temperature), Von Willebrand Factor.​ and proteins C&S, transport, and 10-15 ml/unit, 10 albumin, heparin, sodium reconstitutes quickly (3 units/dose​ citrate in 4-factor min with injectable Frozen product, must concentrates (Octaplex).​ water) and efficiently. be thawed before use ​ Dose is 1000-3000 units Granulocytes ABO typing preferred but (INR dependant)​ Antibodies not necessary.​ Refrigerated product​ Immune globulin Primarily used to No ABO replace fibrinogen. May or Rh typing required​ be used to replace other Requires co- factors when more administration appropriate therapies are of Vitamin K​ unavailable. Used to reverse certain anticoagulants or replace low clotting factors in liver disease NEARPOD QUESTION 2 NEARPOD QUESTION 2 YOU ARE TRANSPORTING A MULTI-SYSTEM TRAUMA PATIENT FROM A SMALL COMMUNITY HOSPITAL TO A TRAUMA CENTER. DISCUSS WHAT BLOOD PRODUCTS YOU WOULD LIKE TO BRING ALONG FOR THE TRIP. HOW WOULD YOUR CHOICES DIFFER IF YOUR TRANSPORT TIME IS 2 HOURS VS 20 MINUTES?  TRANSFUSION REACTIONS Hemolysis Blood group incompatibility​ Causes hemolysis of red blood cells​ S/S: Fever, chills, back pain, chest pain, dyspnea, hypotension, DIC, hemoglobinuria​ Treatment: Stop the transfusion, treat hypotension, diuresis​ Erythroblastosis fetalis Rh incompatibility between mom and fetus.​ Occurs when mom is Rh neg with anti-Rh antibodies and fetus is Rh pos.​ Causes massive hemolysis in fetus​ Requires prior sensitization (Rh incompatible transfusion, previous pregnancy with Rh pos fetus)​ Rhogam immune globulin can prevent antibody development if given during pregnancy​  TRANSFUSION REACTIONS Transfusion-related lung injury (TRALI) Etiology not well understood. Appears to be antibody or neutrophil- related immune response.​ Risk factors include any direct lung injury, sepsis, pancreatitis, shock, overdose, major trauma​ S/S: Acute onset severe dyspnea (