Fluids challenge – Shock

Last Updated on by frcemuser

Indications

  • hypotension
  • oliguria

Rate of administration

  • give 500mL crystalloid over 20-30 minutes

Objectives

target MAP (non-invasive)

  • 65mmHg usually OK, may need to higher for the hypertensive patient

target urine output (non-invasive)

  • e.g. 0.5mL/kg/h

resolution of end-organ malperfusion (non-invasive)

  • resolution of tachycardia, improved LOC, falling lactate, rising ScvO2 (aim > 70%)

Ultrasound and echocardiography(non-invasive)

  • optimal filling state (e.g. atrial pressures, IVC diameter, ventricular filling and EF)

Cardiac output monitoring

  • e.g. cardiac index, stroke volume, stroke volume variation

Predicting Fluid Responsiveness

Bedside assessment:

  • Observations,
  • Capillary refill,
  • Urine output,
  • Straight leg raise test,
  • USG for IVC Collapse,
  • Bedside ECHO/Thorax scan for obstructive shock due to Tamponade/Pneumothorax.

Treatment:

  • Judicious Fluid Bolus (Crystalloids/blood in hemorrhagic shock)

Reading

Fluid Responsiveness

 

Was this article helpful?

Related Articles

Leave A Comment?

This site uses Akismet to reduce spam. Learn how your comment data is processed.