Wikibooks: Emergency Medicine/Blood and Fluids

= Fluid Blood Resuscitation = = Topics = Available IV Fluids = Blood products = Fluid Selection Exercises = IV Drips with Exercises = = Which Fluid to use? = = What are you fixing? = Hypoperfusion / hypotension = Dehydration = Symptomatic anemia = Acute blood loss = Ongoing hemorrhage Coagulopathy? = Maintenance / NPO = Electrolyte imbalances = = Fluids = Dextrose / Free Water = Crystalloid = NS LR Ringer’s Acetate = Colloid = Albumin Hetastarch Modified gelatin Dextran = Hypertonic Saline = Non blood based Oxygen Carrying = Hemoglobin based fluorocarbon based = Blood products = = Dextrose = D5 = 1 Liter = 170 calories = D10 D20 D50 = = requires central line = = Crystalloids = Hypo oncotic = Ratio of 3 1 for acute blood loss = 1 L NS → 275 cc into vascular space = + 825 cc into interstitial volume = 1100 cc = 1.1 L ??? = = Crystalloids = Saline = NS ¼ NS ½ NS = LR = Hypertonic Saline = Others = Normosmol (acetate) = Plasma Lyte (gluconate) = = LR = [Cl]LR → [Cl]plasma = Calcium can bind to rx’s including citrated anticoagulant in blood products = → Cannot use LR as the diluent for blood transfusions = = Crystalloids = NS or LR? = Lots of NS can ↓ intracellular K and cause ↑Cl acidosis = LR can increase lactic acidosis = Neither one has been shown to be superior = ¼ NS ½ NS = Hypertonic Saline = Others = Normosmol (acetate) = Plasma Lyte (gluconate) = = Others = Normosmol (acetate) Plasma Lyte (gluconate) = Additional buffers pH → pHplasma = Mg = Careful in RF or insufficiency = = Others (cont’d) = 8% Amino Acids = Osmolality 950 mOsm/L = provides protein in varying percentages assists with tissue repair and to correct negative nitrogen balance = Intralipids 10% 20% = isotonic = provides fatty acids and calories = EtOH = 5% Alcohol in 5% Dextrose = 10% = = +/ Dextrose = All of the crystalloid fluids = D5 D10 D20 D50 = = Colloids = Albumin 5% 25% = Hetastarch = Dextran 6% 10% = Gelatin = = Why Colloids = Oncotic pressure → fluid remains intravascular = No risk of infection = Heat treated ...