Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

NADEEN ISMAHEL FY1 FLUIDREVIEWANDGENT AMICIN PRESCRIBINGCONTENTS FLUIDREVIEW GENT AMICIN Fluid types Background Fluid regimens Dosing Important considerations Side effects Tips and tricks Tips and tricks Examples ExamplesSCENARIO Scenario:ou’re an FY1 and you get bleeped during your night shift to fluid review Mr Smith a 79 y/o man who’s current fluids have just finished. What are some questions you’d like to ask the nurse prior to assessment of Mr Smith? - What was he admitted with? - NEWS score? - Is he nil by mouth? - Is he managing any oral intake?FLUIDLOSS It is important to consider the cause of fluid loss in order to decide which fluid type to use for replacement Extracellular Dehydration Blood loss D&V - Pyrexia - NG aspirates - Poor oral intake - Stoma output - Burns - Pancreatitis FLUIDS Crystalloids Colloids 0.9% Saline 5% DextroseHartmann’s Gelatine based Human albuminStarch basedFLUIDS Resuscitation Maintenance 0.9% Saline 5% Dextrose Hartmann’s Hartmann’s 0.9% Saline Gelatine based Human albumin Starch basedFLUIDLOSS It is important to consider the cause of fluid loss in order to decide which fluid type to use for replacement Extracellular Dehydration Blood loss D&V - Pyrexia - NG aspirates - Poor oral intake - Stoma output - Burns - PancreatitisFLUIDLOSS It is important to consider the cause of fluid loss in order to decide which fluid type to use for replacement Extracellular Dehydration Blood loss Hartmann’s - Saline - Saline - Saline - Dextrose - Packed red cells - +/- F, plateletsFLUIDS -RESUSCIT ATION NICE 2017 guidelines Systolic blood pressure: <100mmHg <15 mins crystalloid solution - Heart rate: >90 beats per minute - Capillary refill: >2 seconds or peripheries cool to touch - Respiratory rate: >20 breaths per minute Pulmonary oedema - NEWS: ≥5FLUIDS-MAINTENANCE The traditional regime “1 salty + 2 sweet” 2.5 - 3L/ 24 hours - 1000ml Saline 0.9% (over 8 hours) - 1000ml Dextrose 5% (over 8 hours) intake, fluid status, PMH oral - 1000ml Dextrose 5% (over 8 hours) Other maintenance examples - 1000ml dextrose-saline (over 10 hours) + 1000ml dextrose-saline (over 10 hours) + 500ml dextrose-saline (over 4 hours) - 500ml saline 0.9% (over 6 hours) + 1000ml dextrose 5% (over 10 hours) + 1000ml dextrose 5% (over 8 hours) - 1000ml Hartmanns (over 10 hours) + 1000ml 5% dextrose (over 8 hours) + 500ml 5% dextrose (over 6 hours) FLUIDS-IMPORT ANTCONSIDERA TIONS It is important to assess the patient, look at recent bloods and observations - Systolic blood pressure - NEWS - Pulmonary oedemaU+Es, electrolytes - Peripheral oedema - Heart failure - Fluid balance - input and output -FLUIDS-ELECTROL YTES Potassium 40mmol over > 4 hours Remember Hartmann’s has potassium 20mmol of potassium FLUIDS-SUMMARY In short… Examine patient, check NEWS, check bloods Maintenance Resuscitation Oral intake? 500ml 0.9% NaCl (15 minutes) 1000ml NaCl/ dextrose/ hartmann’s (6-10 hours) +/- 20mmol/ KClFLUIDS-TIPSANDTRICKS In overload give IV furosemide and restrict fluids to < 2L/24 hours - - In patients with ca, urine colour is a good indication of hydration levels - Slow fluids overnight - people don’t typically drink overnight - Avoid 5% dextrose in patients with risk of re-feeding syndrome - IV medications and NG flushes count towards fluid intake - Stoma output, vomiting and drains all count towards fluid outputSCENARIO-QUESTIONS a 79 y/o man who’s current fluids have just finished.ur night shift to fluid review Mr Smith - What was he admitted with? Diverticulitis - NEWS score? NEWS = 0 - Why is he on fluids? NBM - Is he nil by mouth? Yes - Is he managing any oral intake? NoSCENARIO-QUESTIONS Scenario:ou’re an FY1 and you get bleeped during your night shift to fluid review Mr Smith a 79 y/o man who’s current fluids have just finished. - Intake 2L IV today including 40mmol potassium - Renal function normal - No signs of fluid overload or dehydrationsease -SCENARIO-QUESTIONS Scenario: ou’re an FY1 and you get bleeped during your night shift to fluid review Mr Smith a 79 y/o man who’s current fluids have just finished. What fluid regimen will you use? A. Resuscitation B. MaintenanceSCENARIO-QUESTIONS Scenario: ou’re an FY1 and you get bleeped during your night shift to fluid review Mr Smith a 79 y/o man who’s current fluids have just finished. What fluid regimen will you use? A. Resuscitation B. MaintenanceSCENARIO-QUESTIONS Scenario: ou’re an FY1 and you get bleeped during your night shift to fluid review Mr Smith a 79 y/o man who’s current fluids have just finished. What fluid type will you use? A. Colloid B. CrystalloidSCENARIO-QUESTIONS Scenario: ou’re an FY1 and you get bleeped during your night shift to fluid review Mr Smith a 79 y/o man who’s current fluids have just finished. What fluid type will you use? A. Colloid B. CrystalloidSCENARIO-QUESTIONS Scenario: ou’re an FY1 and you get bleeped during your night shift to fluid review Mr Smith a 79 y/o man who’s current fluids have just finished. Prescribe this gentleman appropriate fluids Include fluid volume, type, additions and timingSCENARIO-QUESTIONS Scenario: ou’re an FY1 and you get bleeped during your night shift to fluid review Mr Smith a 79 y/o man who’s current fluids have just finished. Prescribe this gentleman appropriate fluids Include fluid volume, type, additions and timing 1000ml NaCl/ dextrose/ hartmann’s +/- 20mmol KCL over 6-10 hoursSCENARIO-QUESTIONS Scenario: ou’re an FY1 and you get bleeped during your night shift to fluid review Mrs Smith a 60 y/o female who is acutely septic. Admitted with acute pancreatitis NEWS = 6 No history of heart failure or kidney disease Poor oral intake - 1L in 24 hours Bloods - AKI 2SCENARIO-QUESTIONS Scenario: ou’re an FY1 and you get bleeped during your night shift to fluid review Mrs Smith a 60 y/o female who is acutely septic. What fluid regimen will you use? A. Resuscitation B. MaintenanceSCENARIO-QUESTIONS Scenario: ou’re an FY1 and you get bleeped during your night shift to fluid review Mrs Smith a 60 y/o female who is acutely septic. What fluid regimen will you use? A. Resuscitation B. MaintenanceSCENARIO-QUESTIONS Scenario: ou’re an FY1 and you get bleeped during your night shift to fluid review Mrs Smith a 60 y/o female who is acutely septic. What fluid type will you use? A. Colloid B. CrystalloidSCENARIO-QUESTIONS Scenario: ou’re an FY1 and you get bleeped during your night shift to fluid review Mrs Smith a 60 y/o female who is acutely septic. What fluid type will you use? A. Colloid B. CrystalloidSCENARIO-QUESTIONS Scenario: ou’re an FY1 and you get bleeped during your night shift to fluid review Mrs Smith a 60 y/o female who is acutely septic. Prescribe this patient appropriate fluids Include fluid volume, type, additions and timingSCENARIO-QUESTIONS Scenario: ou’re an FY1 and you get bleeped during your night shift to fluid review Mrs Smith a 60 y/o female who is acutely septic. Prescribe this patient appropriate fluids Include fluid volume, type, additions and timing 500ml 0.9% NaCl STATSCENARIO-QUESTIONS Scenario:ou’re an FY1 and you get bleeped at 3am during your night shift to fluid review Mrs Smith a 92 y/o lady who’s fluids have finished On examination - Social admission, unable to cope at home - Appears very underweight - NEWS = 0 - Bibasal crackles - PMH of VSD, T2DM and hypertension - Pitting oedema - Managed 800ml oral intake 8am this morning - Bloods - normalSCENARIO-QUESTIONS Scenario: ou’re an FY1 and you get bleeped at 3am during your night shift to fluid review Mrs Smith a 92 y/o lady who’s fluids have finished Would you prescribe this patient IV fluids? A. Yes B. NoSCENARIO-QUESTIONS Scenario: ou’re an FY1 and you get bleeped at 3am during your night shift to fluid review Mrs Smith a 92 y/o lady who’s fluids have finished Would you prescribe this patient IV fluids? A. Yes B. NoSCENARIO-QUESTIONS Scenario:ou’re an FY1 and you get bleeped at 3am during your night shift to fluid review Mrs Smith a 92 y/o lady who’s fluids have finished On examination - Social admission, unable to cope at home - Appears very underweight - NEWS = 0 - Bibasal crackles - PMH of VSD, T2DM and hypertension - Pitting oedema - Managed 800ml oral intake 8am this morning - Bloods - normalSCENARIO-QUESTIONS Scenario:ou’re an FY1 and you get bleeped at 3am during your night shift to fluid review Mrs Smith a 92 y/o lady who’s fluids have finished On examination - Social admission, unable to cope at home - Appears very underweight - NEWS = 0 - Bibasal crackles - PMH of VSD, T2DM and hypertension - Pitting oedema - Managed 800ml oral intake 8am this morning - Bloods - normalGENT AMICIN What is gentamicin? Broad spectrum antibiotic. Used to treat gram -ve bacteria Common uses: Sepsis - triple therapy - Endocarditis - Meningitisammatory disease - Pneumonia - Urinary tract infectionsGENT AMICIN-DOSING - Narrow therapeutic window - Max 72 hours - Calculated based on height, weight, age and genderGENT AMICIN-SIDEEFFECTS Nausea Ototoxicity Vomiting Nephrotoxicity AnaphylaxisGENTAMICIN-PRESCRIBINGGENT AMICIN-QUESTIONS gent level for Mr Smith a 45 y/o male with urosepsis.anded over to chase a The gent was administered at 11:00am and the level was taken at 07:00pm. The level comes back at 4.2mg/L Plot the level on the graph GENT AMICIN-QUESTIONS and the level was taken at 07:00pm.m The level comes back at 4.2mg/L GENT AMICIN-QUESTIONS Based on your previous answer what dosing window would you choose? A. 24 hours C. Withhold dose and re-check level GENT AMICIN-QUESTIONS Based on your previous answer what dosing window would you choose? A. 24 hours C. Withhold dose and re-check levelGENT AMICIN-QUESTIONS You are an FY1 and about to start yourou have been handed over to chase a gent level for Mr Smith a 45 y/o male with urosepsis. 400mg of gent was administered at 11:00am and the level was taken at 07:00pm. The level comes back at 09:00pm at 4.2mg/L You prescribe Mr Smith the next dose of gent, what time do you prescribe it to be given at? A. 07:00pm B. 11:00am C. 09:00pm D. 11:00pmGENT AMICIN-QUESTIONS You are an FY1 and about to start yourou have been handed over to chase a gent level for Mr Smith a 45 y/o male with urosepsis. 400mg of gent was administered at 11:00am and the level was taken at 07:00pm. The level comes back at 09:00pm at 4.2mg/L You prescribe Mr Smith the next dose of gent, what time do you prescribe it to be given at? A. 07:00pm B. 11:00am C. 09:00pm D. 11:00pmGENT AMICIN-QUESTIONS nismahel 29/05/22 10:45 400mg Nadeen Ismahel fy15/211:00 Ch Lh 29/05/19:00 4.2 30/05/22 11:00 400mg Nadeen Ismahel fy1 31/05/22 11:00 400mg Nadeen Ismahel fy1GENT AMICIN-TIPSANDTRICKS - Only the first dose of gentamicin can be prescribed until a gent level is obtained - Always prescribe the next dose at the time the previous dose was given, not the time prescribed - If asked to chase a gent level, always prescribe the next dose to avoid a missed dose If 8 hour gent level is missed, can always do a 24 hour level - - Daily U+Es for patients on gentamicin - Max 72 hours, seek advice from seniors if required for a longer period - If in doubt, pharmacists are your best betQUESTIONS?QUESTIONS?