CRR

• The two main fluid groups are crystalloids and colloids.
• IV fluids distribute to the body compartments according to their characteristics.
• The electrolyte requirements of the body can be understood through knowledge of the body's fluid requirements.
• Appropriate IV fluid therapy for maintenance of fluid balance can be calculated, selected, and the rate calculated.
• Electrolytes can be replaced in a patient scenario.
• Resuscitation involves intravascular expansion and replacing fluid and electrolyte deficit.
• Medical loss can be due to diarrhoea, vomiting, skin lesions, and other causes.
• The human body is composed of 2/3 water and 1/3 solids, with 40% of the solids being intracellular, 20% being interstitial, 20% being intravascular, and 10% being extracellular.
• Oncotic pressure is the pressure exerted by the colloidal osmotic force.
• The SAFE study compared the use of albumin and normal saline in patients with various conditions.
• The SAFE study was a multi-centre, randomized, double-blind trial published in the New England Journal of Medicine in 2004.
• Central lines are suitable for irritant and non-irritant drugs, rapid fluid replacement, and long term use, but are unsuitable for short term use due to the risks.
• Normal saline is not always the best idea, especially in cases of hypernatremia, problems with chloride balance, where the sodium content of medications is high, hypercalcaemia, tumour lysis syndrome, and acidosis.
• Gravity infusions are suitable for simple fluid and drug administration, straightforward patients, and where accuracy is less important, but are unsuitable for time or rate critical drugs or vulnerable patients.
• Peripheral cannula is suitable for simple fluids and non-irritant drug administration, but not for irritant drugs or long term use.
• The SAFE study found that albumin was not superior to normal saline in terms of mortality, but it did have a lower incidence of hypernatremia.
• A care plan for PC should include management for stroke prevention, rate control, and rhythm control.
• Further information: Proximal leg vein ultrasound scan and D-dimmer test are used in diagnosing DVT.
• Oxygen saturation is 90% on 40% oxygen through a mask.
• Cardiac exam reveals tachycardia with an irregular rhythm.
• A care plan for PC should include management for DVT, monitoring parameters, and a role for interim anticoagulation therapy.
• The patient appears to be in mild respiratory distress with blood pressure of 108/60 mmHg, pulse rate of 140 bpm, respiratory rate of 24/min, and temperature normal.
• Interim anticoagulation therapy is recommended at this stage.
• Electrocardiogram demonstrates atrial fibrillation (AF) with rapid ventricular rate.
• The risk of stroke can be estimated based on CHA2DS2-VASc Score.
• One year later, the patient presents to the emergency department with palpitations, dyspnea, and chest discomfort which began approximately 4 hours ago.
• Sodium and fluid balance in injury involve ADH release, thirst, water retention, sodium retention, and activation of the renin-angiotensin-aldosterone system.
• Assessing fluid needs involves considering general requirements for health, the volume status of the patient, fluid balance charts, and physical observation.
• Develop a care plan for Mrs BP, which considers both pharmacological and non-pharmacological management of hypertension.
• BMI ≥ 30 requires height and weight for QRISK®3 - 2017/18 calculator.
• Ethnicity: Caucasian.
• eGFR: Stage II CKD.
• Focus 2: Conducting a risk assessment using QRISK®3 tool.
• Mrs BP has raised JVP (high predictive value), cardiomegaly on CXR, SOBOE, NT-proBNP.
• PMH: Need to be aware of other diagnoses.
• Leg oedema, and bi-basal lung crackles indicating pulmonary oedema.
• Mrs BP is 5’ 4” (= 162.56, i.e 163 cm tall) & 9st 13lb (=63Kg).
• Glycaemia: She does not appear to have impaired fasting glycaemia.
• NYHA Classification of Heart Failure: NYHA Class I: No limitations, ordinary physical activity does not cause fatigue, breathlessness or palpitation.
• Postcode: Gives an indication of deprivation.