Colloid Hypertonic Saline

The early intravenous fluid administration for resuscitation of the critically ill hypovolemic patient is the corner stone of shock therapy (Kruemer & Ensor 2012). The Surviving Sepsis recommends early optimization in the first six hours, followed with fluid challenges in the case of persistent hypo

Prediction of fluid responsiveness has been investigated to prevent fluid overload because excessive peri-operative fluid administration can be a contributory factor to postoperative complications, prolonged length of hospital stay, organ failure and mortality1-4.

Resuscitation in the ED. Rapid Quantitative resuscitation is recommended in all patients with tissue hypoperfusion. According to the SSC guidelines, the goals of fluid resuscitation include a CVP of 8-12 mm Hg, a MAP > 65 mm Hg, urine

Even though the consequence of saline instillation on a ventilator patient in the acute care setting is pneumonia or the patient may become hemodynamically unstable, this practice remain contentious, the practice of this procedure will also decrease the oxygenation. (Ayhan, et al., 2015),

Furthermore, prompt infusion of antimicrobial agents ought to be priority and this may require extra vascular access ports (Dellinger, et al., 2008). Early goal-directed resuscitation has confirmed to improved survival for emergency department patients presenting with septic shock in a randomized, controlled, single-center study. Resuscitation lessen 28-day death rate (Dellinger, et al., 2008). In a reviewed conducted by Dellinger, et al., (2012) advocated administering one litre of crystalloid or 300-500ml of colloid more than 30 minutes, to accomplish a central venous pressure (CVP) of 8 mm Hg to 12 mm Hg. Volumes ought to be increased if there are huge indications of hypoperfusion (Dellinger, 2014).

The simulation that I experienced today was with an elderly patient that just had a left hip fracture fixed and she was fresh from surgery. The patient was confused and drowsy when she got to me. It was expected that the patient would be like that because of coming out of surgery. Her blood pressure was low because she was losing fluid in the form of blood from her Jackson Pratt drain that was in place. Also she was losing fluid from her left hip dressing. So I did for that was reinforce the dressing. To help with her blood pressure being so low I called the doctor to see what we could do and she suggested that we give normal saline 500 ml bolus over 30 min. After about 15 min her blood pressure was starting to come up and normalize. What

Early hemodynamic assessment on the basis of physical findings, vital signs, central venous pressure, and urinary output fails to detect persistent global tissue hypoxia. A more definitive resuscitation strategy involves goal-oriented manipulation of cardiac preload, afterload, and contractility to achieve a balance between systemic oxygen delivery and oxygen demand. End points used to confirm the achievement of such a balance (hereafter called resuscitation end points) include normalized values for mixed venous oxygen saturation, arterial lactate concentration, base deficit, and pH. Mixed venous oxygen saturation has been shown to be a surrogate for the cardiac index as a target for hemodynamic therapy. In cases in which the insertion of a pulmonary-artery catheter is impractical, venous oxygen saturation can be measured in the central circulation (p. 1368).

Kleinpell, Aitken, and Achorr 2013, recommend that crystalloids solutions, such as normal saline and lactated ringers, or albumin, should be the fluids of choice when initiating fluid resuscitation. Their recommendation is based on a study trial that was conducted to evaluate the effectiveness of artificial colloids. The results indicated no survival benefits when using artificial colloids comparing to crystalloids (Kleinpell, Aitken, and Achorr 2013).

The interventions should be focused on supporting the failing system and include the following: “(1) fluid replacement, (2) airway management, (3) antibiotic therapy, and (4) use of vasopressor” (Latto, 2008, p. 197). Fluid replacement is necessary to expand the blood and plasma volume in order to provide the adequate tissue perfusion and oxygen delivery to the organs. Vasopressors (dopamine, norepinephrine, epinephrine vasopressin) should be used in case the fluid replacement therapy fails to maintain adequate arterial pressure (Latto, 2008). The target central venous pressure should be more than 8 mmHG, the target central venous oxygen saturation should be over 70%. Wide-spectrum antibiotic should be administered as soon as the blood cultures are taken in order to treat the cause of the disease. Serum lactate level should be measured and treated with fluids “if greater than 1.5 times the upper limit of normal” (Latto, 2008, p. 198). Lactate is a byproduct of anaerobic cell metabolism and is one of the indicators of inadequate tissue oxygenation related to sepsis. Moreover, the glucose level, hematocrit and hemoglobin should be closely monitored.

Hypothermia protocol for the post cardiac arrest patient has been an evidence based practice of this therapy for about a decade now. This intervention, often used in the critical care setting, is now expanding to primary emergency responders as well. This paper will present some of the notable research that has been done on therapeutic hypothermia, and current use of this intervention.

Wound cleansing has been discussed about for many years, different solutions and techniques have been discussed to use, and it is an important part of preventing infection. Wound cleansing is described as the use of fluids to remove debris and dead tissue from the surface of the wound. The purpose of wound cleansing is to make the best possible conditions at the wound site, for uncomplicated wound healing. The most commonly used solution would be normal saline due to being an isotonic solution and it does not disrupt with normal healing process of wounds (Ljubic, 2013). Normal saline has just been

“After a traumatic injury, hemorrhage is responsible for 35% of pre-hospital deaths and over 40% of deaths within the first 24 hours” (NTI, n.d.). I have worked in an intensive care unit and on a flight team. During my time as a nurse, I have cared for many patients following trauma. While working on the flight team, I became acquainted with tranexamic acid (TXA) for trauma patients who were actively, or highly suspected of, bleeding. I was familiar with TXA for post-operation coronary bypass patients, but not for trauma patients.

After the onset of hypovolemic shock, the primary goals are to replace blood and fluid volume via IV infusion; maximization of oxygen delivery, and minimization of oxygen demand. Patient is positioned in a manner that supports maximal circulation and airway patency (oxygenation, ventilation, and perfusion). Diligent treatment of fever, fear and pain are necessary to reduce oxygen demand. Humidified supplementary oxygen is given as needed at up to 10 to 15 L/min by non-rebreathing mask or bag-mask ventilation and is monitored continuously through pulse oximetry (McCance, 2010. pp

As you can see in table 3, a small dose of hypertonic saline was far more affective then mannitol in decreased intracranial pressure. “Intracranial pressure fell after administration of a “small” dose of hypertonic saline by 8.83 mm Hg in the first hours and 9.76 mm Hg in the second hour according to the manual data” (Colton et al., 2014). When comparing hypertonic saline to mannitol as well as the other pharmacological interventions, administration of hypertonic saline resulted in a significant amount of reduction in clients with intracranial pressure. Their study also revealed, “mannitol resulted in

Mr George Jensen is experiencing post-operative hypovolaemia from a right tibia and fibula surgery, as a result of falling off the roof cleaning the gutters. It is therefore important to get an understanding of what hypovolaemia is and the pathophysiology behind this condition before treating the condition. According to Kettley and Marsh (2016), hypovolaemia is defined as inadequate filling of blood or fluids within the body’s circulatory system. Approximately one-third of the total body fluid is distributed in the extracellular compartment, of which one-quarter resides within the vasculature. Hypovolaemia can be divided into two separate categories, of which include absolute hypovolaemia, and relative hypovolaemia. Absolute hypovolaemia is usually caused by excessive fluid loss, such as blood loss from trauma or surgery, plasma loss from burns, or ECF loss from diarrhoea and vomiting. Relative hypovolaemia occurs in sepsis and anaphylaxis, where total body fluid content is high but the intravascular compartment is deplete (Kettley & Marsh, 2016). In relation to this, Mr George Jensen would be suffering from absolute hypovolaemia, due to an open reduction and external fixation of his fractures post surgery.