Fluid Responsiveness Study

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

The prevalence of asthma has steadily grown in both the US and world populations, and continues to do so. In the US alone, 25 million people were diagnosed with asthma by 2010 (CDC, 2013). In turn, the need to accurately assess the functionality of a patient’s lung capacity is an essential step to begin diagnosis and treatment of their condition. This paper examines the mechanical peak flow meter, which was crafted for assessing lung function capacity in asthmatic patients. In addition, comparing the advantages and disadvantages of usage of the peak flow meter, as well as the proper usage. Among the various instruments used to assess a patient’s lung capacity, the mechanical peak flow meter is the most widely used and among one of the most precise measurement tools (CDC, 2013).

Similar to Isoflurane and Desflurane, Sevoflurane causes slight increases in CBF and intracranial pressure at normocarbia, although some studies show a decrease in cerebral blood flow. High concentrations of Sevoflurane (> 1.5 MAC) may impair autoregulation of CBF, thus allowing a drop in CBF during hemorrhagic hypotension. This effect on CBF autoregulation appears to be less pronounced than with Isoflurane. Cerebral metabolic oxygen requirements decrease, and seizure activity has not been

The chosen population in this journal were patients with hip fracture at a Swedish university hospital (Nyman, Johansson, & Gustafsson, 2010). Patients with hip fracture experience long periods of bed rest and pain resulting in dysuria, which requires the insertion of a Foley before surgery. The trial started at 6 a.m. on the postoperative day two (Nyman et al., 2010). One group had their catheter clamped and then only unclamped when there was a need for urination, while one group had

The purpose of pulmonary function testing is to determine the overall function of the lungs as it relates to how much gas moves in and out of the lungs, how fast the gas exchange occurs, the stiffness of lung and chest walls, the diffusion characteristics of the alveolar-capillary membrane, and how well lungs respond to therapy (REF 15). Vital capacity of the lungs is measured when, after taking a long, deep breath, the patient exhales the maximum possible volume (REF 15). When the expiration of the volume is forceful, it is defined as forced vital capacity (FVC), which it is the most common way to measure vital capacity (REF 15). Mr. Kostas’ result of FVC 4.1L are only 85% of the expected normal value. FVC is reduced in patients with

Congestive cardiac failure (CCF) is a progressive disease of the heart, which involves loss of pumping ability by the heart. Congestive cardiac failure occurs when the myocardium loses its ability to pump enough blood to meet the body’s metabolic needs and is generally accompanied by fluid accumulation in the body tissues, especially the lungs. The build–up of fluid affects the normal function of the heart, pulmonary circulation, blood pressure, the distribution of oxygen and nutrients, and

The viscosity of a fluid of measured by said fluid’s resistance to the gradual deformation caused by shear and tensile stress and is identified as a property of a fluid in which opposes the relative motion between two different surfaces of a fluid both moving at different velocities. A fluid that has no resistance to shear stress is known as an inviscid or ideal fluid. Not every fluid is highly or even somewhat viscous though zero viscosity can only be observed at rather lower temperatures but other than that all fluids can be said to have a positive viscosity and technically are said to be viscid and/or viscous. Though a fluid may only be called viscous if the viscosity of this fluid is substantially greater than that of water but it may be deemed ‘mobile’ if its viscosity is notably less than water. An example of viscosity would be when a fluid is being forced through a tube. The particles that compose the fluid would typically move more quickly near the tube’s axis but slower near said tube’s walls. There are some stresses in which require overcoming the friction between the particle layers in a fluid to keep said fluid in motion and for a given velocity pattern the stress required must be proportional to said fluid’s viscosity. An example of a viscous fluid would be honey, which because of both the high attraction between its particles, and the previously mentioned, resists the urge to flow. An example of a highly viscous fluid would be pitch, which is the

Fluids and electrolytes are vital to human life. The concept of grasping how they play a great role within the human body is complex and delicate; however, it is also essential in determining what fluid does what and how exactly it effects the cells of the human body. As Trakalo (2015) states, “water serves as a medium for metabolic reactions within cells; transports nutrients, waste products, and other substances; acts as a lubricant; an insulator and shock absorber; and regulates body temperature” (p.336). In this essay, the discussion will entail the major fluid compartments of the body, the percentage of fluids contained in each compartment, active and passive transport, osmosis and diffusion, filtration, hydrostatic and oncotic/osmotic pressure, a description of hypertonic, isotonic, and hypotonic fluids, the effects of fluid administration and the classification of all major IV fluids and blood product tonicity.

This is especially important on those patients admitted with low mortality risk DRGs. This is accomplished by identifying and preventing, potentially avoidable complications and adverse events. For example, patients admitted for syncope and collapse secondary to dehydration will more than likely be placed on IV Fluids. One goal would be to hydrate the patient and reevaluate them throughout their hospitalization for improvement. However, if the patient’s intake and output is not monitored closely, the patient can become volume overloaded and develop symptoms similar to those seen with Right Sided Heart Failure. Once that happens, the patient will require additional medications and additional hospital days because of provider error of not placing an order for the Nurses to monitor his/her volume status.

Rather than what variety of fluid to administer, the issue of administration volume has been the issue of greatest concern. Initiating fluid resuscitation with critical non-invasive hemodynamic parameters is relatively straightforward, yet assessing fluid responsiveness, the potential for a positive hemodynamic response to additional fluid volume, is much less clear. Fluid overloading is a concern as it may generate life-threatening pulmonary edema, additional cardiac stress, and peripheral edema6. A range of modalities exist to assess fluid responsiveness with various ranges of invasiveness and skill levels to interpret. Utilizing central venous pressure parameters has not been shown to be efficacious in the determination of fluid responsiveness34. Alternatively, dynamic arterial waveform modalities have been shown to predict fluid responsiveness with a high degree of accuracy in patients on a ventilator35.

The status of the fluid is evaluated through auscultation of breath sounds for crackles, the sounds of the heart for presence of S, daily weight trends and presence of peripheral edema. The presence of pulmonary crackles or the S heart sound confirms there is volume overload in the heart. After discovering overloading in the heart, it is important to take the necessary treatment measures to maintain fluid

ROSC is the result of returned perfusing cardiac activity and is achieved through CPR and resuscitation (I & L). ROSC has been shown to improve through the use of mechanical chest compressions in cardiac arrest patients. A study found that the ability to achieve ROSC is significantly improved by the use of mechanical chest compression devices. The study found that it was improved by 3.1% when the mechanical device was used with 8.3% of patients achieving ROSC, in comparison to 5.2% that received manual compressions (G). Furthermore, out of 43 patients whom underwent CPR using the LUCAS chest compression device, 11 were diagnosed with good neurological function, 65% of which were pulseless when the device was applied (H). This is indicative that this device has the potential to improve organ perfusion and enhance cerebral blood flow to cardiac arrest patients (E & H & L). Despite these results, both studies indicated a need for further testing of the effect mechanical chest compression devices have on ROSC as it is difficult to include the required sample space needed to form any definite conclusions (G & H). A study on swine with prolonged ventricular fibrillation (VF), revealed that continuous chest compressions using the mechanical device improved arterial pressures and cerebral

In this experiment, three variable flow meters are used to alter the flowrate. Changes in pressure drop due to the change in flowrate are then observed from the three pressure gauges that can measure pressure at different range and recorded. The shift from laminar flow to turbulent flow is seen from the results recorded, but it is observed more clearly from the water-soluble dye experiment that was carried out by the demonstrator. Laminar flow turns to be turbulent when the Reynolds Number goes above a certain value, around 2000.

Understanding contraindications with post-operative surgery and surgical stress responses in patients with pre-existing diseases or conditions, is the key pathogenic factor to understand. Post-Surgical stress responses include: Pain, Nausea, Hypoxemia, Muscle loss, Immobilisation and Sleep disturbance etc. Increase on the demand of organ functions and activation of other biological responses in the body, is the result of post-operative surgical stress. These changes due to stress on body functions are believed to be induced by endocrine metabolism and activation of several other biological systems in our body. Although these changes are important for survival, if left prolonged, they may give rise to loss of body cell mass and

has an elevated heart rate, a low blood pressure, and a low/decreased urine output. According to Lewis et al. (2014), these findings indicate inadequate amounts of fluid resuscitation, which indicates the intravascular fluids are continuing to deplete. We need to increase the amount of fluids in this case because if we don’t, then shock will result in the development of renal failure in the patient (Lewis et al., 2014). This isn’t good, so be aware of these findings become fluid resuscitation is extremely important in a burn victim. The nurse will need to notify the physician of these findings, so that way he or she can increase the amount of lactated Ringer’s solution being infused in the patient via large-bore IV’s (16 gauge or higher) or using a central line. According to the University of Michigan (2018), if the urine output is less than 0.5 to 1 mL/kg/hr. (approximately around 30 mL/hr.), then you should increase the infusion of Lactated Ringer’s solution by at least 33% of the patient’s hourly calculated fluid requirements mentioned above. Monitor this hourly; the goal is to get A.N. up to 30