Deliver a fluid challenge safely to an acutely unwell patient

FRCEM EXAM QuestionsCategory: December 2016Deliver a fluid challenge safely to an acutely unwell patient
FRCEM Intermediate Staff asked 10 months ago

An 85-year-old-male patient is brought into AED by ambulance looking unwell. His observations are: temp 39.5°C, BP 90/50, HR 115 bpm, RR 20, O2 Sat’s:94% on air. known case of heart failure. His bloods are shown below:
Hb 12 g/dL (M:13 – 18, F:11.5 – 16)
Platelets 350 x 10^9/L (150 – 400)
WCC 18 x 10^9/L (4 – 11)

A. How will you give fluid? (1 mark)
B. What are non-invasive methods to reassess the response? (1 mark)
C. Bedside method to assess the fluid response? (1 mark)

1 Answers
FRCEM Intermediate Staff answered 10 months ago

A.
-Give a fluid bolus of 500 ml of crystalloid over 15mins and reassessing for signs of hypovolaemia, euvolemia, or fluid overload
B.
– Resolution of end-organ mal-perfusion – resolution of tachycardia, improved GCS, BP, Capillary refill
– urine output – 0.5mL/kg/h
– MAP- 65mmHg
C.
– Ultrasound and echocardiography- atrial pressures, IVC diameter, ventricular filling and EF
– Passive leg raise