FluidTherapyinEDICU.ppt

Fluid Therapy in ED ICU DR: Zohair AlAseri EM/CCM Early Hemodynamic Optimization Understanding the pathophysiology of circulatory dysfunction in shock, trauma, and sepsis help to determine optimum treatment approaches.  Fluid Electrolyte Balance Regulation of Fluid Balance What is the major component of all fluid compartments within the body. Regulation of Fluid Balance Is the relative percentage of water the same for every body or changes?? It changes significantly with age, gender, and adiposity. Regulation of Fluid Balance Extracellular fluid volume is greater in the young and in the male than in the elderly or the female Regulation of Fluid Balance The extracellular fluid compartment contains high concentrations of sodium, chloride, and bicarbonate. Regulation of Fluid Balance Plasma and interstitial fluid are rich in proteins, which determine plasma colloid osmotic pressure. Permeability to ions and proteins varies in each organ. Regulation of Fluid Balance Regulation of Fluid Balance The net fluid filtered through a capillary bed is determined by both the translumenal hydrostatic pressures and oncotic pressures. Fluid Imbalance In Shock State Cellular Pump Failure In Shock Control of body water and its composition involves: Shock  Shock  In approximately 50% of septic patients who initially present with hypotension, fluids alone will reverse hypotension and restore hemodynamic stability Shock Fluid Imbalance In Shock State In severe (ED) or long-standing (ICU) shock : The restoration of intravascular volume alone is insufficient for successful resuscitation. ? Cellular effects of ischemia. Fluid Imbalance In Shock State A progressive increase in intracellular Na and water and extracellular K occurs with an associated decrease in extracellular water. This accounting for the loss of functional extracellular fluid volume. Indices of successful resuscitation in ER Indices of successful resuscitation