![Page 1: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/1.jpg)
FluidsIntro to Clinical Practice (ICP) 2017
![Page 2: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/2.jpg)
Faculty/Presenter Disclosure• Faculty: Anthony Seto
• Relationships with commercial interests:– Not applicable
![Page 3: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/3.jpg)
Copyright• Ihavetakentheappropriatestepstoensurethattheuseofthirdpartymaterial inthispresentationfallsunderfairdealingintheCopyrightAct.
• http://library.ucalgary.ca/copyright/fair-dealing
• Thismaterialwascreatedforstudentsofficiallyenrolled intheUndergraduateMedicalEducationprogramandcannotbereproduced,retransmittedorcopied.
• Ihaveproperlycitedthirdpartymaterialinoneofthewaysoutlinedbelow.
CopyrightUnknown http://lindsay.ucalgary.ca
OrderanAnkleX-rayif:• BonetendernessatA• BonetendernessatB• Inabilitytobearweight
bothimmediatelyandinED
©OttawaHealthResearchInstitute,1053CarlingAvenue,Ottawa,Ontario,Canada,K1Y4E9
![Page 4: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/4.jpg)
Fluids Objectives1. Markersofvolumestatus2. Pediatriclevelofdehydration(Gorelick)3. Shockddx review4. Fluidstypes5. Fluidsboluses6. Maintenancefluids7. Fluidadminroutesandstrategies8. Practicecalculationsthroughcases
![Page 5: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/5.jpg)
BrainstormMARKERSOFVOLUMESTATUS
![Page 6: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/6.jpg)
Point-of-careULTRASOUND
![Page 7: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/7.jpg)
JVP – Bedside U/S
Source: “The EDE Book”
![Page 8: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/8.jpg)
IVC – Bedside U/S
Source: “The EDE Book”
![Page 9: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/9.jpg)
Adult classes of shock
HR/RR BP Lethargy
1L 2L >2L
https://lifeinthefastlane. com/wp-content/upl oads/2011/06/Cl ass -of-haemorrhagic-shock-JPEG2.j pg
![Page 10: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/10.jpg)
Peds Gorelick Criteria• Caprefill>2secs• Absenttears• Drymucousmembranes• Illgeneralappearance
• 0to1:<5%dehydration• 2:5-10%dehydration• 3to4:>10%dehydration
![Page 11: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/11.jpg)
AHSPathway(normalvitals)
![Page 12: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/12.jpg)
AHSPathway(normalvitals)
![Page 13: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/13.jpg)
![Page 14: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/14.jpg)
http://pert.ucalgary.ca/pathways/reference/Revised%20ED-UCC%20pathway%20Oct%2025%202011.pdf
AlbertaHealthServicesAcuteChildhoodVomitingandDiarrheaPathway
![Page 15: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/15.jpg)
ReviewSHOCKSCHEME
![Page 16: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/16.jpg)
Fluid Types• Crystalloid(e.g.NS,RL)• Blood/bloodproducts(e.g.RBCs)• Other• Dextrose(e.g.D5W“5gDin100mLW”)• Bicarbonate• Colloid– (e.g.albumin)
![Page 17: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/17.jpg)
Fluid Combo Examples• D5W-NS• KCl 20mmolinNS
![Page 18: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/18.jpg)
Fluid Boluses• Adult• Typical:1Lstartwithr/a• Resus:1-2Lor30mL/kgstartwithr/a• Cautious:250-500mL(i.e.concernof
fluidoverload/pulmonaryedema)• Peds• Typical:20mL/kg x3prn
![Page 19: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/19.jpg)
Routes of admin• Peripheralline• IV• IO
• Centralline• CVC
• Special• Hypodermoclysis (clysis)• EasyIJ
![Page 20: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/20.jpg)
Strategies of Bolus• Gravity• Infusionpump• Pressurebag• Rapidinfuserpumps• Push-pull
http://cdnll.marketlab.com/images/xxl/disposablepressurei nfusionbag.jpghttps://www.smiths-medical. com/~/media /M/Smiths-medi cal_ com/Images/Import%20Images/Level%201/H1200sil opng.png?mw=391
![Page 21: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/21.jpg)
Maintenance Fluids• 4-2-1rule(togetmL/hour)• 4mL/kgperhourforfirst10kg+• 2mL/kgperhourfornext10kg+• 1mL/kgperhourforeachkgafter20kg
• Weight+40(togetmL/hour)if20kg+• 40+20+1*(weight– 20)
![Page 22: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/22.jpg)
Parkland Formula• Tocalculatefluidsrequiredforburnpts• RLusedsincelargevolumerequiredand
morephysiologicthanNS• DetermineTBSA(totalbodysurfacearea)
with2° burns(partialthickness)orgreater• Parklandformula:4xkgx%TBSAburned• 50%ofthattotalvolumeinfirst8h• 50%ofsametotaloverfollowing16h
![Page 23: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/23.jpg)
http://www.hardyakka.co
m.au/med
ia/w
ysiwyg/burns_d
iagram
.jpg
https://im
age.slidesharecdn.com
/burnp
ptshashi-130
6090
13746-ph
papp
01/95/burn-ppt-sha
shi-2
7-63
8.jpg?
cb=1
3707
4196
9
![Page 24: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/24.jpg)
Cases• Peds Sepsis• Peds Gastroenteritis• Burn
![Page 25: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/25.jpg)
Urosepsis• Case:8monthFwithUTI.Tachycardic,
poorcaprefill,lethargic.• Weight=10kg• WhatisyourIVfluidstrategyand
amount?
![Page 26: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/26.jpg)
Gastro• Case:5 y.o.Mwithgastroenteritis.After
fluidresuscitationintheERtoneareuvolemia,hestillfeelsunwellandrefusestoeat.Hewillbekeptovernight.
• Weight=18kg• WhatisyourIVfluidstrategyand
amount?
![Page 27: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/27.jpg)
Burn• Case:30y.o.M(70kg)hasburnstohalf
hisback,posteriorfullrightleg,andposteriorfullrightarm.
• WhatisyourIVfluidstrategyandamount?
![Page 28: Fluids - University of Calgary in Alberta · • To calculate fluids required for burn pts ... 30 y.o. M (70kg) has burns to half his back, posterior full right leg, and posterior](https://reader034.vdocuments.net/reader034/viewer/2022042113/5e8ef45ac513222ef429ec56/html5/thumbnails/28.jpg)
Summary• Usemultiplemarkerstogetherto
determinevolumestatus+freq reassess.• Gorelick:caprefill,tears,MM,look• Shockddx:hypovolemic,distributive,
cardiogenic,obstructive• Peds bolus:20mL/kgx3prn• 4-2-1rulecheat:wt +40(if20kg+)• Parklandformula:4xkgx%TBSA