Vascular access and fluid management

 Vascular access and fluid management

We tend to forget that we humans (and many of our animal relatives) are mostly water. When we think about it, we must marvel how the body stores the bulk of this water in cells and the interstitial, extracellular fluid, where much of the water is tied up in gel. Suspended in this interstitial lake is the vascular compartment, comparatively puny in volume but most important because of its rapid transport of fluids, nutrients, and waste throughout the system, and its continuous and efficient exchange of water with the interstitial compartment (Fig. 3.1). Clinically, we can see dehydration in sunken eyeballs, wrinkling skin and dry lips, or the excess of fluids in edema and swollen eyes; we can even hear it should water collect in the alveoli.


Comments

Post a Comment

Popular posts from this blog

Early post-operative care - Anesthesia

Image
  Post-operative care The post-operative care of the patient can be divided into an early and a continued phase. The early phase lasts from the moment the patient leaves the operating room until he is discharged from the Post-Anesthesia Care Unit (PACU) or its equi-valent. The care is then continued, a phase that can extend for days or even weeks. Early post-operative care Based on his medical condition and the planned operative procedure, we will have classified the patient as ambulatory (also known as outpatient), as ‘post-operative admit’ (the patient comes to the hospital on the day of the operation and is admitted to the hospital after his operation), or as an inpatient (the patient is already in the hospital, or will be admitted for pre-operative preparation, and will stay there post-operatively). Two categories of patients might bypass the PACU (formerly called the Recovery Room): (i) ambulatory patients who had a minor procedure and are expected to be ready for discharge in a m
Read more

Fluid requirements - Fluid management

Image
  Fluid requirements We calculate the intra-operative fluid requirement as follows:   ·             Maintenance  The 4–2–1 rule (Table 3.7 )provides a guide for hourly isotonicfluid requirements.   For a 70 kg man, this would amount to 40  +  20  +  50  =  110 mL/h.   ·             Fasting replacement  We apply the 4–2–1 rule for the duration of fasting andreplace 50% over the first hour, then 25% over each of the next two hours. ·             Insensible losses  2 mL/kg/h.   ·             Urine output  Replaced mL for mL.   ·             “ Third space ”  losses  Transfer of fluid to this sequestered, extravascular space occurs with surgical trauma, and must be replaced with isotonic solution in the short-term: 4–8 mL/kg/h depending on the degree of surgical trauma, e.g., peripheral operation vs. open abdomen.   ·             Blood loss  We replace small amounts with crystalloid (3 mL per mL bloodlost); in larger resuscitations, colloid and/or blood is administered 1:1 with blood loss.
Read more

Treatment for Diseases of the Spinal Cord - Myelopathy

  Treatment : A complete diagnosis is very important for necessary treatment. If the disease is due to the compression of the spinal cord, it is important to decide if surgery is possible or not. Surgeries ranging from, long, complicated microsurgery; to the surgeries to dissolve tumors with the help of ultrasound (CUSA) are now available in our country. Surgery of the spinal cord is normally not dangerous, but it is undeniable that the operation has to be done very delicately, skillfully and systematically, because the spinal cord is very narrow and congested with innumerable nerve fibres. Thus, to prevent any damage, the surgeon has to be very cautious during surgery. The non-compressive disorders are treated according to the underlying cause like: ·             Treatment for TB. ·             Use of steroids for the treatment of multiple sclerosis and other demyelinating diseases, as well as collagen diseases.   ·             Vitamin deficiency is treated accordingly.... etc. Specif
Read more