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Dehydration – Fluid Optimization

           Presentation
           Patient is 11 months of age
           Impaired conscious level
           Very dehydrated
           Cold peripheries
           Prolonged cap refill
           Weak peripheral pulses.
           But he was also malnourished.

           The question then is “how much and how quickly can fluids be given”?




www.uscom.com.au                                The Measure of Life
Dehydration – Fluid Optimization
           Treatment
           Fluid boluses




       Result                CO       0.09 - 0.65
       SV     0.8 - 6.3      CI        0.3 - 2.2
       SVI    2.7 - 21       SVR    40,000 - 3297

www.uscom.com.au                   The Measure of Life
Dehydration – Fluid Optimization




               SVI    2.7      - 21     - 31     (Typical 36-45)
               CO     0.09     - 0.65   - 0.96   (Typical 2.5-3.5)
               CI     0.3      - 2.2    - 3.2    (Typical 4.2-5.5)
               SVRI   12,000   - 9891   - 1096   (Typical 800-1200)


www.uscom.com.au                             The Measure of Life
Dehydration – Fluid Optimization


           Summary
           “We were using the USCOM in particular to look at his
           CO and SVR to see if we were improving things or
           making matters worse.”

           Conclusion
           USCOM confirmed individual response to therapy and
           inspired confidence in the decision of fluid loading.




www.uscom.com.au                                The Measure of Life

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Case Study - Pediatric - Dehydration - Fluid Optimization

  • 1. Dehydration – Fluid Optimization Presentation Patient is 11 months of age Impaired conscious level Very dehydrated Cold peripheries Prolonged cap refill Weak peripheral pulses. But he was also malnourished. The question then is “how much and how quickly can fluids be given”? www.uscom.com.au The Measure of Life
  • 2. Dehydration – Fluid Optimization Treatment Fluid boluses Result CO 0.09 - 0.65 SV 0.8 - 6.3 CI 0.3 - 2.2 SVI 2.7 - 21 SVR 40,000 - 3297 www.uscom.com.au The Measure of Life
  • 3. Dehydration – Fluid Optimization SVI 2.7 - 21 - 31 (Typical 36-45) CO 0.09 - 0.65 - 0.96 (Typical 2.5-3.5) CI 0.3 - 2.2 - 3.2 (Typical 4.2-5.5) SVRI 12,000 - 9891 - 1096 (Typical 800-1200) www.uscom.com.au The Measure of Life
  • 4. Dehydration – Fluid Optimization Summary “We were using the USCOM in particular to look at his CO and SVR to see if we were improving things or making matters worse.” Conclusion USCOM confirmed individual response to therapy and inspired confidence in the decision of fluid loading. www.uscom.com.au The Measure of Life

Notas del editor

  1. Hypodynamic circulationExtremely Low SVI – 2.7 - 21(Typical 36-45)HR 112-103HypovolemiaExtremely highSVR – 40,000 - 3297 (Typical 1500-2000)Extremely highSVRI – 12000 – 9891 (Typical 800-1200)Low CO – 0.09 - 0.65 (Typical 2.5-3.5)Low CI – 0.3 – 2.2 (Typical 4.2-5.5)Low Vpk – 0.2 - ? (Typical 1.1-1.6)
  2. Hypodynamic circulationLow SVI – 31 (Typical 36-45)HR 102Normal SVRI – 1096 (Typical 800-1200)Low CO –0.96 (Typical 2.5-3.5)Low CI – 3.2 (Typical 4.2-5.5)Low Vpk – 1.2 (Typical 1.1-1.6)