1. Fluid Management Karl Wagner MD MHMC August 2007

2. Fluids are good right? Sky’s the limit?

3. How do I know someone needs fluid? Physical Exam– HR, BP, Mucous membranes, UOP, Orthostatics, Sensorium Lab evaluation– Hct, pH, urine specific gravity, Sodium (urine and serum), chloride, BUN/Cr Invasive testing– a-line, CVP, Swan

4. Are you dry sir? Have some high test. CrystalloidColloid Blood products

5. Crystalloid D5WLRNaClPlasmalyte Hyper, iso, hypotonic Salts Maintenance v. replacement

6. Colloid Starches – penta, heta Albumin – Heated 60C for 10h, not infectious Blood – later secret slides Oncotically active Long T1/2 SAFE Trial

7. Periop Fluid Mx How much volume do I start with? How much do I loose? How much do I give back?

8. How should I get started? 4,2,1 rule Deficit Losses– secretions, blood, third spacing, urine, sweating, evaporation, other… Stress of operation

9. Blood Transfusion ABO system Rh system TypingScreening Cross Matching Time

10. What’s in blood anyway? Whole blood PRBCsFFPPlateletsCryo

11. Complications Hemolytic reactions– acute, delayed Nonhemolytic reactions – Febrile, urticarial, anaphylactic, TRALI, Graft v. host, post transfusion purpura, immunosuppression Infections – HIV, Hep a-z, CMV, parasites and bacteria

12. Massive Transfusions Rapid infusers Coagulopathy Citrate tox Hypothermia Acid/base balance Potassium

13. Since blood has risk… Autologous transfusion Blood salvage and reinfusion Normovolemic hemodilution Donor directed transfusion

14. If you wanted to read on your own…. Morgan and Michail Chapter 29. Third edition.

15. Go forth and fill the intravascular space