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FLUID AND ELECTROLYTE BALANCE. HOMEOSTASIS n Normal hydration balance –Intake equals output »Quantities of water and electrolytes entering body are.

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Presentation on theme: "FLUID AND ELECTROLYTE BALANCE. HOMEOSTASIS n Normal hydration balance –Intake equals output »Quantities of water and electrolytes entering body are."— Presentation transcript:

1 FLUID AND ELECTROLYTE BALANCE

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3 HOMEOSTASIS n Normal hydration balance –Intake equals output »Quantities of water and electrolytes entering body are equivalent to quantities exiting n Intake –All water entering into body »Digestive system (liquids, solids, metabolic sources) n Output –All water excreted from the body »Lungs, kidneys, skin, intestines

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5 HOMEOSTASIS (CONT.) n Maintaining a constant stable internal environment n Fluid levels decrease: –ADH secreted –Kidney tubules reabsorb more water back into blood and excrete less urine –Thirst sensation stimulates one to drink –Restoration of fluid volumes to normal values n Fluid levels rise –Kidneys activated to excrete more urine –Water shifts from one compartment to another maintaining balance

6 BODY WATER n Most abundant substance in human body –60% of total body weight in adult male –52% of total body weight in adult female n Acts as universal solvent for bodily solutes n Solvent –Fluid in which another substance will dissolve n Solute –Substance that is dissolved in a solution n Solution –Liquid containing dissolved substances

7 FLUID COMPARTMENTS n Two major fluid compartments –Intracellular fluid compartment »Includes all water (and electrolytes) enclosed by cell membrane »Constitutes 75% of all body water »40-45% of body weight –Extracellular fluid compartment »Composed of all fluids found outside of the cell »Constitutes 25% of all body water »15-20% of body weight

8 FLUID COMPARTMENTS (CONT.) n Divisions of extracellular fluid compartment –Interstitial fluid »Fluid between the cells and outside of the blood vessels »Constitutes 17.5% of extracellular fluid –Intravascular fluid »Fluid found within circulatory system »Water within blood vessels »Constitutes 7.5% of extracellular fluid

9 FLUID COMPARTMENTS (CONT.) n Transcellular fluid –Specialized fraction of extracelluar fluid –Seperated from other extracellular fluids by layer of epithelium –Includes: »Cerebrospinal fluid »Intraoccular fluid »Synovial fluid »Serous fluid within body cavities

10 DEHYDRATION n Definition –Loss of water and electrolytes n Etiology: –Gastrointestinal losses »Vomiting »Diarrhea »Malabsorption disorders

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12 DEHYDRATION (CONT.) n Etiology: –Increased insensible loss »Fever »Hyperventilation »High environmental temperatures –Increased sweating »Medical conditions »High environmental temperatures

13 DEHYDRATION (CONT.) n Etiology: –Internal losses »Third spacing »Peritonitis, Pancreatitis, Bowel obstruction »Poor nutritional states –Plasma losses »Burns »Surgical drains »Fistulas »Open wounds

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16 DEHYDRATION n Management –Ensure adequate airway and ventilation –Administer oxygen and monitor delivery with oximetric monitoring –Monitor cardiac rate and rhythm –Establish IV isotonic crystalloid solution »LR/NS » ml/hr »Fluid challenge

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18 Edema n Edema is the accumulation of water in the interstitial space due to disruption in the forces and mechanisms that normally keep net filtration at zero. n Mechanisms of edema –A decrease in plasma oncotic force –An increase in hydrostatic pressure –Increased capillary permeability –Lymphatic channel obstruction

19 Edema n Can be local or within a certain organ system –Sprained ankle vs. pulmonary edema n May be generalized n Water in interstitial spaces is not available for metabolic processes in the cells.

20 OVERHYDRATION n Clinical Presentation –Peripheral edema –Heart failure –Pulmonary congestion n Management –Remove excess fluid –Diuretic therapy

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23 ELECTROLYTES n General Information –Substance that dissociate into charged particles when placed in water –Ions »Molecules that possess a positive or negative charge »Total number of positve ions equals total number of negative ions n Electrical neutrality law »Cations have positive charge »Anions have negative charge »Electrolytes measured in milliquivalents per liter (mEq/L)

24 NONELECTROLYTES n Solutes that dissolve in water, but have no electrical charge n Nonelectrolytes do not release ions n Solid molecules are usually measured in grams and milligrams n Examples: –Glucose –Amino acids –Urea

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26 ESSENTIAL CATIONS n Sodium (Na+) –Most abundant extracellular cation –Regulates water distribution –Helps transmit nerve impulses –Normal value: mEq/L –Hypernatremia: elevated serum sodium –Hyponatremia: reduced serum sodium

27 ESSENTIAL CATIONS (CONT.) n Potassium (K+) –Most abundant intracellular cation –Mediates electrical impulses in nerves and muscles –Helps transmit nerve impulses –Normal value: mEq/L –Hyperkalemia: elevated serum potassium –Hypokalemia: decreased serum potassium

28 ESSENTIAL CATIONS (CONT.) n Calcium –Most abundant cation –Function: »Bone development »Blood clotting »Muscular contraction »Aids in nerve impulse transmission –Normal value: mEq/L –Hypercalcemia: elevated serum calcium –Hypocalcemia: decreased serum calcium

29 ESSENTIAL CATIONS (CONT.) n Magnesium (Mg+) –Necessary for biochemical functions –Coenzyme in protein and carbohydrate metabolism –Aid in transport of sodium and potassium across cell membranes –Normal value: mEq/L –Hypermagnesemia: elevated serum potassium –Hypomagnesemia: reduced serum potassium

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31 ESSENTIAL ANIONS n Chloride (Cl-) –Regulates fluid balance and renal function –Follows sodium –Participates in acid/base balance –Normal value: mEq/L n Bicarbonate (HC03-) –Chief buffer in body –Neutralizes hydrogen (H+) ion and other organic acids –Normal value: 21-25mEq/L n Phosphate (HP04-) –Important for energy stores –Intracellular buffer, aids renal function

32 Dispatch Information n Your paramedic rescue is dispatched to a bus stop for a reported “sick person.” © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

33 Initial Impression n 46 y/o female n Sitting on bench n Appears weak, looks “ill” n Pale, dry skin © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

34 Assessment n Your partner performs a verbal assessment, as you take vital signs. © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

35 Assessment n Patient states that she has been ill for the past week and has missed dialysis three times. n She was on her way to the dialysis center when she felt “too weak to continue.” n Vital signs: –HR = 102 –RR = 22 regular –BP = 156/110 –SpO 2 = 97% room air © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

36 Discussion n Considering the limited information you have, what is at the top of your differential diagnosis? n What additional information would you like to have? n What are your immediate concerns? © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

37 Assessment/Treatment n The patient is placed on O 2 via nasal cannula at 4 Lpm. n You and your partner assist the patient to the stretcher and move her to the ambulance. © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

38 Assessment n Patient states past medical history of: –Hypertension –Renal failure »Dialysis 3X week n Medications –Verapamil (Calan, Isoptin) n No known drug allergies © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

39 Detailed Assessment n PEARL n Lung sounds –Rales/Crackles to the bases bilaterally n Positive pitting edema to periphery n Noticeable ascites n Muscle weakness to extremities © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

40 Detailed Assessment n You place the patient on the cardiac monitor. Figure © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

41 Treatment/Assessment n IV access –20 g angiocatheter –1000 mL bag of normal saline –Macrodrip set »Keep vein open n Blood glucose –172 mg/dL © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

42 Detailed Assessment n You and your partner prepare the patient for a 12- Lead ECG. © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

43 Detailed Assessment © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ Interpretation?

44 Discussion n How has the information provided affected your differential diagnosis? n What information strongly suggests the presence of hyperkalemia? n Do paramedics carry medications that can be used for the treatment of hyperkalemia? © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

45 Treatment n Your partner begins transport to the ED. n You contact medical control and inform the receiving physician of your findings. © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

46 Treatment n ED attending agrees with your suspicion of hyperkalemia and orders you to administer: –CaCl 2 : 5–10 mL IV –50 mEq of sodium bicarbonate –1 mg/kg of lasix –Albuterol 1 unit dose © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

47 Discussion n How do the administration of these medications help the hyperkalemic patient? © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

48 Treatment n You administer the medications as ordered. © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

49 Ongoing Assessment n Vital signs after medication administration –HR = 102 –RR = 22 regular –BP = 154/102 –SpO 2 = 99% now on 10 Lpm via albuterol mask inhalation © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

50 ED Treatment and Beyond n ALS continued n Blood chemistry –Acidosis present n Blood labs –Potassium returns 7.6 mEq/L n Patient immediately dialyzed n Admitted for observation © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

51 Epidemiology n In U.S. hyperkalemia is diagnosed in up to 8% of hospitalized patients. n Mortality rate for severe hyperkalemia is as high as 67% if not treated rapidly. –Primary cause of death is impaired cardiac function. © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

52 A & P Review n Potassium is an important ion. n 98% of potassium (K + ) in body is intracellular. –Ratio of intracellular to extracellular K + is important in creating cellular membrane potential. –Small changes in extracellular K + can have profound effects on cardiovascular and neurological function. © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

53 A & P Review n Cardiac depolarization possible because of concentration gradients that exist between intracellular and extracellular K + and sodium (Na + ) n This electrical and concentration gradient maintained by the Na + /K + -ATPase exchange pump –Pump controlled by insulin and  -2 receptors © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

54 A & P Review n Na + /K + -ATPase pump –Moves 3 Na + out for every 2 K + in –Creates: »Chemical concentration gradient »Electrical concentration gradient Figure © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

55 A & P Review n Action potential in cardiac muscle cells –Polarization (resting potential) »Na + /K + -ATPase creates chemical and electrical gradients across myocardial cell membrane. n More K + inside, more Na + outside cell n Greater positive charge outside, greater negative charge inside cell »Resting, or membrane, potential of myocardial cell about -90mV © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

56 A & P Review n Action potential in cardiac muscle cells –Depolarization (action potential) »Stimulus results in change of resting potential and depolarization »Initially, Na + fast channels open, allowing Na + ions to rush into cell n Inside of cell rapidly becomes more positive, about +30 mV n Na K pump starts pumping Na out of cell »Na ion channels close, Ca + slow channels open, increasing intracellular Ca +, roughly balancing the loss of + sodium ions. © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

57 A & P Review n Action potential in cardiac muscle cells –Repolarization »Slow Ca + channels close, slow K + channels open »+ Potassium ions move out of cell, resulting in rapid repolarization and restoration of resting potential to -90 mV –After repolarization, Na + /K + -ATPase pump begins exchanging the extracellular K + for intracellular Na + © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

58 A & P Review n Action potential in cardiac muscle cells –Refractory period »Period between depolarization and repolarization where myocardial membrane will not respond to another stimulus –Relative refractory period »Strong enough stimulus can result in depolarization. »Adequate K + and Na + ions have been exchanged to allow depolarization. n Gradients have been reestablished. © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

59 A & P Review © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ Fig 3.5-4

60 A & P Review n Myocardial electrical conduction system does not have the Ca + influx typical of myocardium action potential. –No “plateau” –Shorter absolute refractory period –Allows for rapid discharge rates © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

61 A & P Review n Total body K + stores approximately 50 mEq/kg n Normal serum K = 3.5–5.0 mEq/L –Serum K + via blood chemistry used to determine presence of hyperkalemia –Hyperkalemia defined as serum K + > 5.5 mEq/L © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

62 Pathophysiology n Causes of hyperkalemia: –Decreased excretion »Renal failure: most common cause »K-sparing diuretics »Urinary obstruction »Addison disease »Sickle cell disease »Lupus © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

63 Pathophysiology n Causes of hyperkalemia: –Extracellular shift of K+ »Acidosis »Cell necrosis »Insulin insufficiency »Medication effects n Digitalis toxicity n Succinycholine  -blockers  -blockers © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

64 Pathophysiology n Causes of hyperkalemia: –Additions into extracellular space »Hemolysis n Venipuncture n Blood transfusion n Burns n Tumor lysis »Increased intake n IV, PO administration n Rarely a cause of hyperkalemia © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

65 Pathophysiology n Resting membrane potential related to ratio of intracellular:extracellular K + n Hyperkalemia partially depolarizes the cell membrane and altered cellular function –Cardiac muscle cells: dysrhythmia –Neurons: altered mental status –Skeletal muscle cells: weakness © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

66 Pathophysiology Cardiac toxicity is the most serious effect of hyperkalemia and does not necessarily correlate with serum levels. © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

67 Clinical Assessment n History –History of renal failure? »Acute, chronic –Other significant medical history? »Addison’s, lupus, sickle cell disease, TI diabetes –Medications? »K supplements, K-sparing diuretics,  -blockers, insulin, digitalis –Recent trauma? »Rhabdomyolysis, burns, tumors, venipunctures © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

68 Clinical Assessment Any patient with a history of renal failure who presents with cardiac dysrhythmia should be considered hyperkalemic until proven otherwise. Especially if they’ve missed dialysis! © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

69 Clinical Assessment n Signs and symptoms –General malaise, weakness, paralysis, paresthesias –Palpitations –Edema, skin changes typical of Addison’s, lupus –ECG changes © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

70 Clinical Assessment n ECG changes in hyperkalemia –≥ 5.5 mEq/L: T wave abnormalities –≥ 6.5 mEq/L: intervals widen –≥ 7.0 mEq/L: P waves flatten, QRS widens –≥ 8.8 mEq/L: P waves disappear –≥ 10 mEq/L: sine wave pattern © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

71 Clinical Assessment n Consider the following ECG: Figure © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

72 Clinical Assessment n Note: –No P waves –Wide QRS Figure © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

73 Clinical Assessment Take-home point: There are many other ECG changes associated with hyperkalemia other than peaked T waves! © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

74 Treatment n Three goals for treatment of hyperkalemia: –Stabilize the myocardial membrane. –Move K + from the intravascular space to the intracellular space. –Remove K + from the body. n Treatment is individualized, determined by patient presentation, potassium level, and ECG. © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

75 Treatment n Ensure adequate oxygenation and ventilation. –High-flow, 100% oxygen –BVM ventilation, intubation if necessary n IV access –Large bore angiocatheter –Withhold fluid administration in patients with renal failure. © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

76 Treatment n ECG monitoring –Rule out dysrhythmia n 12-Lead ECG –Rule out AMI © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

77 Treatment Based on patient history, physical exam findings, and ECG, medical control may order the administration of specific medications available in most paramedic formularies to achieve the three goals of treating hyperkalemia. © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

78 Treatment n Goal: stabilize the myocardial membrane. n Administer calcium. –CaCl 2 : 5–10 mL IV »27.2 mg Ca ++ /mL –Ca gluconate 10–20 mL IV »9 mg Ca ++ /mL n Ca ++ potentiates the toxic cardiac side effects of digitalis, withhold in suspected or known dig toxicity! © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

79 Treatment n Goal: promote an intracellular K+ shift. n NaHCO 3 : 50–100 mEq IV –Alkalosis, or correction of acidosis drives K + intracellular n Insulin/glucose –10 units regular insulin –50 g glucose n Albuterol: 15–20 mg nebulized © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

80 Treatment n Goal: promote excretion of K + n Furosemide: 40 mg IV –Only administer if patient can produce urine –Not effective in cases of complete renal failure © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

81 Treatment: Hospital n Continued airway maintenance and ventilation with 100% oxygen n Cardiac monitoring n 12-Lead ECG n Labs –Serum potassium determination –Digitalis levels, if appropriate n Blood chemistry –Resolve acid-base disturbances © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

82 Treatment: Hospital n Specific treatment, if not provided in field n Stabilize the myocardial membrane. –Calcium n Promote an intracellular K + shift. –Sodium bicarbonate –Insulin and glucose –Albuterol n Promote K + excretion. –Furosemide –Dialysis –Kayexalate © 2007 by Pearson Education, Inc. Pearson Prentice Hall, Upper Saddle River, NJ

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84 OSMOSIS n Definition and description –Fluid compartments are seperated by semipermeable membranes (pores) –Semipermeable membranes »Specialized biological membrane that surrounds cell and encloses blood vessel walls –Certain materials are allowed to pass through freely »Oxygen »Carbon dioxide »Water –Larger compounds are restricted »Proteins »Large sugars

85 OSMOSIS (Cont.) n Definition and description –Movement of a solvent (H20) through a semipermeable membrane from an area of lesser (solute) concentration to an area of greater solute concentration in an attempt to equalize the concentration on both sides of a membrane –Form of diffusion

86 OSMOSIS (Cont.) n Description –If one side of membrane has a higher solute concentrate than the other, a pressure gradient exists (pulling force) and water moves from the side of lower concentration to higher concentration until both sides are equal –Concentration of water to solute molecules should remain balanced on both sides of membrane

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88 OSMOTIC PRESSURE n Definition and description –Pressure established as a result of unequal solute concentration across a semipermeable membrane n Osmotic pressure control –Chief factor controlling water distribution –Water moves toward the highest solute concentration –Sodium is most prevalent extracellular cation exerting osmotic force

89 OSMOTIC PROPERTIES n Determined by number of particles in solution –Not by weight or molecular charge n Greater number of solute particles in solution –Greater osmotic pressure of that solution –Greater difference of dissolved particles on opposite sides of membrane n Osmolarity –Concentation of osmotically active particles in solution –Measured in milliosmoles –Plasma contains 300 milliosmoles/liter

90 COLLOID OSMOTIC PRESSURE (ONCOTIC PRESURE) n Fraction of total osmotic pressure exerted by colloids (proteins) n Proteins are large molecules that do not readily cross capillary walls or cell membranes n Colloid osmotic pressure is immensely important in maintaining fluid within vascular space n Albumin/Chief plasma protein

91 TONICITY OF BODY FLUIDS n Definition Tonicity –Number of particles present per unit volume n Isotonic solution –Solution containing same concentration of dissolved particles n Hypotonic solution –Solution having a solute concentration lower than that of bodily cells n Hypertonic solution –Solution having a concentration greater than that of bodily cells

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94 ACTIVE TRANSPORT n Movement of molecules against a concentration gradient n Faster than diffusion n Requires energy and utilizes carrier molecules n Example: Sodium/Potassium pump

95 DIFFUSION n Definition and description –Molecules or ions in solutions move from regions of higher concentration to regions of lower concentration until both sides of membrane are equal –Process results in uniform distribution of diffusing substance –Movement is opposite that of water movement n Facilitated diffusion –Requires “helper proteins” to cross the membrane –Requires energy and must follow a gradient –Example: Insulin/glucose relationship

96 Intravenous Therapy n The introduction of fluids and other substances into the venous side of the circulatory system –Replaces blood lost through hemorrhage –Electrolyte or fluid replacement –Introduction of medications directly into the vascular system

97 Blood and Blood Components n Plasma –Mostly water with proteins and other dissolved elements n Formed Elements –Erythrocyte –Leukocyte –Thrombocyte

98 Fluid Replacement n The most desirable fluid for blood loss replacement is whole blood. –Blood is often fractionated »Packed cells and plasma n Blood must be typed and cross-matched to prevent a severe allergic reaction.

99 Fluid Replacement n Transfusion reaction –Occurs when there is a discrepancy between the blood type of the patient and donor –Signs and symptoms of a transfusion reaction »Chills, hives, hypotension, palpitations, tachycardia, flushing of the skin, headaches, loss of consciousness, nausea, vomiting, or shortness of breath

100 Fluid Replacement n Transfusion reaction (cont.) –Treatment »IMMEDIATELY stop the transfusion »Save the substance being transfused »Rapid IV infusion crystalloid solution »Administration of mannitol (Osmotrol), diphenhydramine (Benadryl), or furosemide (Lasix) –Be alert for signs of fluid overload and congestive heart failure.

101 Intravenous Fluids n Hemoglobin-based oxygen-carrying solutions n Colloids n Crystalloids

102 Hemoglobin-Based Oxygen- Carrying Solutions (HBOCs) Hemoglobin-Based Oxygen- Carrying Solutions (HBOCs) n Commonly referred to as “blood substitutes” –Compatible with all blood types –Do not require blood typing, testing, or cross-matching –HBOCs do not contain RBCs, so there is no concern for Rh incompatibility because the Rh factor of blood is found on the outer surface of the RBC. n Initial studies on HBOCs have been disappointing

103 Colloids n Colloids remain in intravascular spaces for an extended period of time and have oncotic force. – Plasma protein fraction (Plasmanate) – Salt-poor albumin – Dextran – Hetastarch (Hespan)

104 Crystalloids n Crystalloid solutions are the primary compounds used in prehospital care n Non-protein solutions –Normal Saline –Lactated Ringers n Classified according to tonicity – Isotonic solutions – Hypertonic solutions – Hypotonic solutions

105 Crystalloids n Awareness of the effects of hypertonic, isotonic, and hypotonic solutions on red blood cells.

106 Thank you!


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