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just wanted to check. Can you guys hear me? Okay. Yes, I can hear you perfectly. Thanks. And this session recorded or certain courted, recorded just like the previous ones and uploaded on to the metal up. And this evening, And if anyone kind of access the metal up, please just be for you to and drop is a meal and and no drinking I'll see my cinema emails coming through, and so we'll just get started. All here. So you're keeping anyone behind and this is gonna be Session five in the loop. Siris call surviving the probably. And today's topic will be on Doctor my patients. Words have finished, and if anyone has any questions, just feel free to drop from the chart or on mute. And it's been a long from me covered elastic. What's the big before? They said numerous Spartans know, knows how to do, but it's where people contacted me, and it shouldn't make you cry, but sometimes it might. Honest said, it's good fashion accessory for your script problems. Your bleeps should be used for sick patients and urgent tasks, and it's way for different specialties to get in contact with you for example, if there's today, we're talking about fluids. If biochemistry and they need to speak to the phone call for, say, surgery about a patient you need and they're croutons. 400 needs a farce. Five. It's way for those specialties to get called up you to really urging results or urgent you sort of results that might need action. So it's a way for the nursing staff of the word stopped getting called. Give it sick patients or even the medical regimen. Or, you know, other doctors that you're working with to let you know about someone that sick that might need to review some point during the course of the day or evening. Or like if you're on like chips. It's one of the most common bleep scenarios. You'll get a snap phone, depending where you're whether you're northern and and Southern Maryland, somewhere in the UK or further way it will be. Do you want to describe more fluids for this patient? I know in the Southeastern Trust in a line system called a Tums on D, there will be at least seven of these tasks. Brittle fluids of finished reserve. You please side here, like where every fluids. It's one of those common things you can get asked to do. Is an Apple missions to review some spirits? That's pretty neat. The nice and easy thing today. We can also take quite a lot of time of patients on whale on the certain things to consider when you're going to review salon fluids. So what was your initial thoughts be if you got a bleed? Where there was a task online to say, Please be a patient's fluids? Some of the things you might need a consider is. Why is the patient in a hospital? You know, Are they sick because they wouldn't? Sometimes you might get people that are medical effect or they just need social work. But just ask up saying, You know they need fluids in your normal Why do they need fluids? If things are they a surgical patient or the medical patient at my sort of determine what type of food you prescribed for the vision or how many? How much fluids that might need? You don't think you should really septic early on whale. How much fluid do they need? How much of that already had? You also want to consider what would there you're not be if someone bleep Shin said. You're not going to be this person's foods. It could be two o'clock in the morning. Your thing, then we'll we don't drink fluids overnight were asleep, so I didn't need IV fluids, but something you could consider asking when you're getting that. Initially, it would be What's in your life was everyone's target. Your life is more than 30 miles an hour. Three. Difficult to monitor in someone who's not catheterized possible. But if you're catheterizing you being asked to review a few just like to consider. If you're not on the ward, they've got a break about it. You're on the phone. Just say to the meeting. We'll see you on my butt because it might. If the urine output stolen from, say, 30 to 5, you're gonna need to go interview dot Freshen for the urge like, but it wasn't in the 30. You might not need to go and see them for another authority. If you're more urgent or priority tasks today, you also want to think to yourself. Do they actually need fluids? That's a sad, you know, 2000 more than most people don't drink leader of foods overnight, but again, throwing hospital. We're probably going to be on whales. Maybe they do need fluids, particularly if they're quite dehydrated or they got a lot of bosses. And you're sort of thing, too, shall find much period of already had today, something that road builder was. Just find a letter of medical necessity but not thinking that, you know, when you're a hospital, you can also drink, and it's also something to consider. How much would it if they had today? And what about the biologics and the opposite infusion? You're going to have some magnesium used to put it in, say, 100 million bag off sailing as the billing works with our to settle things to consider whenever you go to prescribe someone fluids. That's definite simple. I think all the white lines and after him just going on, Why do we actually prescribed plates? Screws? Some of the mean reason to prescribe it is to replace any lost One will let you might have by MG by vomiting. Diarrhea still are Patryan catheters chin. Sure, you've got a maintenance of your daily requirements. Patients might be another by mice for example, they've gotten ideas there know by mice you still need to be hydrated. Might be to replace the blood loss, you know, Obviously, fluid doesn't go to repeat the hemoglobin. But if they're in head of Olympic shock when you can't get there isn't you know it'll make quickly. The blood pressure's looking right. Well, listen, the bit of fluid distribute the BP a little bit. And I said, For it's also doing for drugs, not staph me, something I forgot about as an afternoon. I am on a study from working on any and making up drugs myself that you realize that people have to get quite a lot of fear. Just three antibiotics. Check your referral so it tells them three times a day. That's 300 mils fluid going into them that we may be husband felt a bit before. Now, when you're going to see someone always think about sure deficit what their maintenance foods for? Do they have any losses? But also come this patient or a fruit? Because if they could drink orally and like a meet the target early, then they don't need IV fluids. No, everyone that comes in the hospital will need IV fluids. That's just something to consider. I think something that we all sort of forget about it a little bit. So whenever you go to assassinate for meeting fluids before Carias that you tend to think over, some sent me something. I tend to think off it be the assessment of the fluid status. You want to take a history from the patient. Have they just come in the hospital and they had parole and take for the past five days? They're gonna be very clinically dry. That's something to be important on, something to certainly think about. What have you go to assassinate in for fluids? Where they vomiting? Do they have diarrhea? Have they have they had temperatures and they're spiking temps. The shred. Either reason. Fluids. I'm sort of three, their skin from sweating or the very thirsty. Do they have a dry moist is their total crocked and dry where their lips try and any sort of comorbidity is abusive out in the history? Certainly, and do they have renal failure? Do they have congested party out failure? Have been told that ever had fluid in the lungs before excessively to consider, we think about how much fluid you're going to give someone or the Rebif you to give some. You know, we want your clinical exam and just like a sort of a general end of the better inspection. I appreciate your old sort of enough cereal at the minute, and hopefully you have seen some patients whose that it may be medicated britishers, but also people that are quite clinically on the way out. And you get a sort of a feeling for someone who looks terrible. And they just looked very sick. And you can sense up from when you look at them at the end of the bad day. Just like a measurable. They're very dehydrated. But in your clinical exam, you don't think about what's their heart rate. Do you know? Are they talking? Maybe they're talking because they're very dehydrated. Is the Risperdal too? Rita is the respect to read because they've got fluid in there. What do they have? A chest infection. That's where the respect your weight's up. Well, sir, BP. You have given someone. Well, this is a fluid. Yes, I've got a partial drop. Yes, affects them. Initially, we also you think about what medication should be C will be on Got a postural drop in the BP You look at the cup a refill time and then sent me Just look at the JVP. You don't like what? Do they have any pulmonary edema? You You might be able to hear that on all split a shin but you certainly won't be able to see it And but you will see it in your chest X rays. Do they have any preference demand by preferable Mean I killed him on if that you have it is a pity on all that on somewhere. I certainly forgot to check it out, but about remembering to do to see, really they got their skin turns her is it interview Pinch It remains pinched for a while, or does it sort of go back immediately? But the mucus memory and strong and do they have sort of soak in dry eyes in terms of living on them would be technical monitoring your liver. It's a new start. Look at the BP on their heart rate, particularly look at the after spiking temps. That's when you're speaking. Attempt you might be sweaty. You're also losing fluid. Not since you look at the fluid, balanced her and simply looked here. And I could make sure they're meeting the requirement off, you know, standard more than 30 minutes an hour. Also looking. See after dreams. He's a little bit recorded. Um, fluid balance. Start water and they've got a and a multi arthritis from not dream. You'll tell me what you get those in surgical patients, but you know, medical missions kind of chest runs do have any catheters. Animal. That's a more accurate way of recording something journal, but is most trouble or if they're just passing your and energy jobs will also be recorded on the grill. Belcher's All the Stoma was on that come with the height, you know, high volumes tomorrow, but you're gonna order place that ever being almost in that the might also have a daily with a truck. AM started shorts on a card action. I could do a a chart, particularly in the liver unit and if the one for his mind Spironalactone for ascites and also cardiology. If they're on freezing right and it's important to be looked at their lab investigations, you don't look at the you know, you look at the urea that growling were their electrolytes And you never did have renal impairment. Know what the third book contests on? A smooth come back. You're like, really hyper limit for the evil. Or do they have to much rid of the hyper they would be the fork areas you'd want to say. Ask whatever you're assessing someone that's do they need to fluids? Do you think that shock? This is the center definition, and I'm not gonna board you were going into the physiology behind it. And but, you know, it's sort of side leader and tissue hypoxia on Let's do the reduced oxygen delivery or increased option and consumption or a combination of those processes. Now, this is 40 AM sort of areas where prosecutions of shock something that you probably will come across maybe already halved your in your office here or throat unique. Protect me enough for be high problem. Am shocked that I have acute loss of circulating blood for the, um, obstructive shock. You typically want to see this on last year, maybe respiratory enough or in any if someone's got cardiac tamponade today. Attention, You know that needs to be released immediately, and that's causing the shock. You do have a mass of subtlety. Cardiogenic shock. You might see this to that kid coronary syndrome. Do they ever with me is for somebody to be TV F Nothing endocarditis or myocarditis? He and unlike you to see that as an athletic, you know, some general medicine. But you might see if you're in cardiology is not full. We also did a distributive shock. Not be enough. Lactic septic shock in your generosity. After meals he distributed shop. In that sense, and a lot of people that come in the hospital, we'll meet the sepsis. X criteria on the diagnosis was helping Well, so what do you do? You ensure? What's the vascular disease? Normally, it's treated with no 0.9% sodium chloride. Another is what we call just look whenever sincerely, on a surgery, you know, you will typically see people just be in Buddhist Hartmann's and but most medical words. And everywhere else we use normal. I've fallen into the trump myself. San Normal saline snow 0.9% sodium chloride. We We should avoid the terminal most dealing with a small, normal world guilty of Santa. That's certainly a fluid balance starts. It's better to write no 0.9% sodium chloride. Whenever you're prescribing in shock, you're trying to prescribe them bonuses and you prescribed them bonuses of 500 mils I'm assets and, well, we sort of free, elaborate a patient. Or it could be someone that younger, just very mild nurse. You don't want to vote. It's the 500 mils. There's a risk, you know, for long term, you typically start with 250 miles off the quick free or the round of treatment. Got CCF and normally prescribe that as a start and only take so expecting to 20 minutes for it, sort of any amount of stopped wanting to run through efficient. After you get your first fullness, you don't dress. Ask, deficient on repeated if it's required. Now, as an F one, you can do with a patient with type of limit shock, and you can give him up to two liters before you need to speak further. Help. Certainly, when I was an F well, once you reach number leader and how I have a number, you just have someone else call me like Like I've given them a liter. Half. I'm gonna give them another 500. Is there anything else I should do here? Or do you think I should get you know? Do you want to come on this? Ask them. You know what I think we need? I see for this patient, because once you've given them sort of 2 2.5 m, you might start to think did any pressors unless something you wouldn't give it a ward and sort of prescribed initial would be distributive shock on Harold Limit. He don't really prescribe an obstructive trouble or cardio cardiogenic drug is used to treat the underlying calls. They're not being acute coronary syndrome or, you know, subtle pee. That's that's why you would do it. And it should write the indication. Be a bolus. The debt were five years behind the and, you know, like the volume 500 mils, no 5000.9% saline. You don't have anything enjoyable, Miss Any dose from 15 minutes to the road over stopped like that's just a standard prescription off a bolus of fluids. And you will see that a lot of people in any you'll just get bonus to leader. They can get up to two ***. It's even on the maintenance leads. The three key elements would be. What funding do you need you to think about the energy sources on the electrolytes? The mousse. Adults need about 30 miles per kilogram, most later today, and that works under but a maximum of two leaders in the female in 2.5 from you or other him. Sort of curious or exceptions to that route. You don't think about the energy source, for most people need about 5200 g of grams of glucose a day. Hartmann's injections will provide this energy source of patient is, it says here. Patients, you know, eating and drinking that might not need IV fluids. Then I just meet that energy source through the food, and you don't think about their electrolytes. So potassium was probably the most important one. You give a minimal kilogram per day October 60 to 80 minimal the maximum you can never put in the Bible. Florida sporting of the moles and either an antibody rather be 500 mils. For a leader you can only ever confuse about a really tall timber. The malls, your arm, Oxy. Um so the quicker she can never get a bag of food was 40 millimoles and it would be over four hours. Miss something. You make seeing a sedative award. Nowhere really else will do it. Except maybe G. I fast route and or surgery would be 500. Nobody was 40 millimoles of potassium in it, running it over four hours. I am. You might see some different descriptions, and I see when your enough to. If you have that job and so something you worry about, you shouldn't prescribe fluids for more than 12 hours at a time. So you shouldn't really be prescribing with fluids for, say, 24 hours sort of borderline. You should describe your bag of fluids and then come back and reassess the patient after you prescribed that bag. I appreciate some of your shifts might not be 12 hours you're gonna live in. That would be 12 hours, but certainly if you're only prescribing fluids, it should really only be for 12 hours at a time. And I said you need to review them after that 12 more by just to see if they need any more IV fluids where they meet? Are they drinking enough during the day to meet their target? Something about the press lots of the three men includes your ability. 5%. Dexter's no 50.9% saline. Hartmann's surgeons upset your apartment. Selection him. Look for the words Just use saline and extras. But surgical ward. You'll always see heartens. So 5% actors. You never use it initially. Or if you're trying to resuscitate someone because it's factory, you just get in the water and it isn't really gonna do anything. There's all the risks associated with it. I am cerebral edema, hyponatremia on yourself. Remember, people, you're giving them a lot of sugar, so they become quite hyperglycemia and and people can be in shock kind of DKA. And that's why we don't just pull those people. That's like Zantac sugars. But we mainly use ceiling. You kind of a big apartment as well. But most people just stick with ceiling see lines very good for your upper GI. I losses surgeons of apartments for the lower GI, and all since that being stupid losses or diarrhea to go scenario here. So you got 63 year old lady. Just 65 kg. And she's admitted for elective right hemicolectomy. In the next 12 hours, she's gonna be no. Then with from midnight, and you've just been a spinning or just prescribe for some fluids and she's gonna be no. Then released. So when you're working, you do your 30 miles per kilogram per day. That works out of the 1950. And Mills, it's not like 250 leadership, which is approximately two liters. So you want to get them about a leader bag over 12? Ours just gonna be a little bit my see, I need to provide some energy and electrolytes suit. If anyone's there, you might want to type in Or certainly, um, you don't just say what you would prescribe. No, it's okay. Typical prescription would be either either of saline or later apartments. If you're gonna give someone later a saline. You also want to remember they're gonna have to have a calcium requirement if they're gonna be No, But my So you need to make that you need a and meet those electrolyte apartments would be nothing wrong with either of these prescriptions on you. Just write the indication commitments. You're at the date. On the time that you're gonna be prescribing the food, it's gonna be a leader. Bye. You know, quit 9% saline with 40 minute most of potassium and 83 meals. And or or you can write that is just 12 already. And you're right, your signature. Or you can give them a little bag apartments. If you aren't adding anything to it, please make sure you put a line through it and someone might come along and add something to it. And that's not something you wanted to be out of it. You have an adverse incident from it, so it's always just support to score any books you're gonna feel. There's nothing on driving either of those, but excess is a standard reaching bag. Repeat, patient is fasting. Do you think about the depths that the older patients will come in with woman diarrhea? Or they might have a high school or or um, I have a list. And for a smaller or double obstruction, we've got fluids correct around G tube. It's gonna have to call it. You have to cut. Cut the estimate nursery. Cocky with deficit, choose the most appropriate fluid, usually going to be no 0.9% sodium chloride or heartburns of It's in the word diagnose, and you want to sort of replace that were 24 to 36 hours. You don't want to just go in for losing fluids. You also need to monitor their response to it. So you think about a deficit. You've got a mild deficit. Might be slightly thirsty. I have a dry, moist, but they've got a stable news. Otherwise, so they're probably gonna need about 1 to 2 leaders. Is the maintenance. If you've got a moderate deficit, for example, they're quite thirsty there. Tachycardia. You've noticed that, but a reduced year and I put on there Capri four times a week, and they got a bit of hypertension. The standalone. There's a bit of a mind electrolyte disturbance, and you're only really be doing your nose morality or you re sodium's. If you're looking at hyponatremia without to talk for a different day, I'm not sort of indicates that they're quite dry on the might need an actual you know, two leaders or so just to build it back up again. And if some of that severe deficits of the really trying because membranes the heart gets it about 100 210 which is still exclude. And they're not making any urine. They're quite cool and clammy. They're probably gonna need quite a lot of food. Um, and you might see quite started electrolytes, for example, the ground and could be 300 plus in the urea as quite high as my aunt's. That's where he's buried, right? And they're going to be quite a lot of fluid. It's all right, doesn't said, if you to be prescribing them bonuses or maintenance. But if you're starting to get above the two leaders that some someone to call in contact for him at that point. Definitely half woman, even Eisen. Actually, Sometimes you know, we don't really like to give people more than four leaders moxa day before you would be thinking do the maybe need to go to Hitched to your I see do we maybe need to get reliable and do any dialysis. So whenever you're sort of that was deficit, you think about ongoing losses. You want to calculate the estimate of volume that they've potentially lost and use that with yesterday's new bones and nurse is very good and they call you with your bowels and that you know, if there's a deficit, birth, their sharpness, words when you want to replace the same volume within appropriate fluid. That said for your knees. CNN with passing property idols Is that being vomiting? Angina? It's anyone ease apartments for the word Seattle. Since what about the stomach or diarrhea? And you always want to replace those Lawson's within the next 24 hour period, just to make sure that shouldn't really make 70. Think about. Gosh, like you're thinking about more vomiting and energy aspirations, my will be diarrhea and stuff like that. All right, have a mystery. So where would you need anything? When is that? When is your food requirement going to be increased? If you got a fever, If you got high heart rate may be because you're high heart rate of your heart or spiritually give you because you're quite dry. If you get diarrhea and vomiting if you have a surgical drink. If you got you got stolen, you got third spacing. For example, of pancreatitis patients with a bottle strapped your postop road, me you know, in Seattle, Surgical order hitched, um, severe pancreatitis. People are getting creamed 4 to 6 liters of here today just to replace appear that they're easing into the third species and they always become quite damage us that will eventually settle as the pancreatitis settles. But it's not uncommon. Wasn't affluent to be on the water, and the consult will say in about 4 to 5 liters of here today. And you're thinking I've only ever been told to try it for 12 hours, But then there's 12 hours. They could get 2 to 3 liters. Sending that, they've got to pay possibility. History. Close. Your thinking about surgery on sepsis is gonna be when you might have an increased food or army. So when would you then prescribe last notes for patients, particularly if they're held after elderly? And if they've got congestive heart failure? It's like a real impairment. You don't wanna be flooding the Ms fluids because the kidneys can't cope with that. And then we'll become shocked. The milk and congestive heart failure after prime ulnar extract that resting three feedings. Um, hum, I'm certainly things you'll see on the G I ward if any of your we're gonna be doing general medicine. It's you. You're certainly some sewage cover. The were demon professional spit. So decompensated LD you might have patients that are in a stroll. We're gonna be detoxed off the alcohol and And when you do, electrolyte profile is for those stations really important to do a bone marrow from the magnesium? Patients are at risk of re feeding syndrome, and you're gonna be replacing the magnesium, replacing the false bit. Said those electrolytes after winter supplementary bags of fluid on the house to be taken into consideration when you're gonna be prescribing the medicine a little areas Well, so someone's going to get kidney injury and again evil just on finals. Not content. Salt your intelligence. Bye. Symptoms that you might see. You might get a build up of nitrogenous weeks product. See, make it nausea and vomiting. Right development. It may be a bit confused or have a reduced want to, since level or yourself might notice the trend in the Bloods and that you see an increase in the urea crowning and you won't see a decreasing you. Jeff. Four labs, certainly in the store he had a chance to look up the CRE or use it or if you're still in your case, minutes and just ask someone on the ward. If anyone has an a k I. And if you can use their you're gonna take a look in DC are for you to show either. Unique labs are very good at ular hurting you when there is an acute kidney injury. But you can also noticed the trend of when someone's beginning to get a big bit dehydrated. And we can also try and prevent that acute kidney injury just by looking at their urine. They're crowning. This was in acute kidney injury is gonna be classified into the three time getting up. Prerenal get arena, not extreme. And let us definitely something you all see in hospital. You'll see all three of them. It's a pre renal issue toe on acute reduction in renal profusion, and that'll be caused by have a belly. Make sure you feel like she had heart failure. If you've got an obstruction of the renal vascular and then you start to get compensated, the medicine is, um, for that, and that's been a result of that increased urine osmolality and increased your specific gravity. Sort of a reduced, Um, recently, Um, you gotta reduce your e. So do you miss indications? Almost 50 hydrated and you want to finish it? Culture store The renal confusion. So moving on to Reno then and something you'll certainly see. It would be cute. Tribuna, Cruces. That's often from a skin nick damage or prolonged renal. Okay, I on what you see there, people might have Coca Cola your and under your deductible in to get the calls of the Echo I with this daughter protein there. Patients with Q Tribuna cosis often will need a referral to Reno on their sort of alluded thrashing them to maybe go dialysis sort of stern hospital. So if you see someone with your kidney injury, you don't think it's hyper of mimic, and you don't think it's so you don't think it's pretty renal or post renal. You think it's a Reno cause of it. It's always important to Lincoln, the renal team. Then order more blood and investigations and help directly treatment. West patients and hospital went with this injury, and sometimes in some serious the do you use it before they have a low threshold, for sure, and I'll, since a woman who was a short term intermittent post renal will be your urology issues. And she usually something obstructing urine retract not only to be in the room in the wall or my side of all of your chart, are you diagnose. It would be you want to do an ultrasound renal track, and you're basically you're looking for a stone or a same structure or a tremor inside the urinary tract. Well, within the ultrasound renal, it's going to clap. That's also, you know, even from Hydronephrosis. And the treatment would be to try and relieve the obstruction whether they'll be your record setter. Suprapubic catheter You might need a stent might need enough to put it on a sudden years and one more look for doing. But it's something to think about it. If you think someone is extremo those, get a little exercise and then contact your allergy with the result of them to everyone. Success with a B, C D E. And it's the chair like finals and half a little slight trend for everyone. But you also the ABCDE of a naked eye. So if you know if someone has got naked eye on the blood, certain things to think about whenever you're going to review them or whatever you're thinking about how you treat this AKI. Then you want to look at the medications to look at their cardiacs and look to see if they're on any nephrotoxic medications so that your insides are they, um, metformin or their own diarrhetics. So the only S inhibitors your ARBs you're looking think moving on to be, then sort of doing it a boost. This patient's BP. And look at the trend on the BP. If they're starting to slowly drop a little bit Thurman 10 like that, I just need a bit of fluid to try and boost of a pressure back up a bit. See you in a calculate the fluid belt. Is this person quite dry? Do they need maintenance? Pill is just to keep them taking over for your life. It isn't break or if they're or lend. It hasn't been great because of reading about merger. Well, they just don't feel like doing much Western Hospital, do you Quick dip stick of year and it's very quick Bedside test. You can do understand she was there an infection there. And if there is an infection, maybe that's maybe no one else has picked up. When we get the good of a urine infection will only needed someone to barracks. And But if you're depressed again, I always don't forget about extending an obstruction. If someone has a catheter in in the urine I purchased from nine her drop little. The first thing you should do is just when they feel new. But ask someone different. Your catheter. If northern the word is free to do it. It's very quick and easy as a half one. You just need a cough. 30. It's orange, bowl of and star in water, and you basically just take about a started water. Put it into your syringe and flush the copier, plus the fluid and try and aspirin like it might be a simple is that it could be a kink in the carpet or cheaper. There could be a clot in there. I am. Well, maybe that could be an obstruction. As I said before, the good of hydronephrosis in there, it's not making your case. You might want to think about either changing their catheter or getting, um, ultrasound and then called doctor urology with the results of that everything about example. So, Mr Smith, he's 45 year around here, Excellent today any of the severe vomiting you a 70 kg. And he said that he is suspected of having viral gastroenteritis. And he currently isn't able to told her any world fluids because that keeps vomiting. You performed your initial assessment, and the patient is tachycardia and hypertensive heart. It's 100 on the book pressures 99 over 74. So how would she proceed? I don't even like to type into the chart and just say what you do or feel free to commute, and I appreciate it's a Monday morning after Monday afternoon after Easter. She might not want to, and that's fine, but so no one would like to. Do you want to give him, um, a bowl ists of know? Put name percent ceiling? Yeah, certainly. And that's part of the first thing you do. You don't give them a flare bolus. Do you know what 9% saline don't have anything and prescribe it doesn't stop. You want to reassess, man after you give your fluid bolus is that he might need to your three. Just the boosters. Bob Pressure Backup told his normal would be. And you also want to think about you need a monitor, this lounger and I. He's losing quite a lot. Same vomiting, and he's not taking a huge lengthen, so he's probably not going to be produced in another year. Uh, this was the main aim for your life. It's gonna be more than 30 miles an hour when I dearly am in patients that are quite unwell. Gastroenteritis. You don't need to cauterize them, But if they're your septic or they're gonna be in hospital for a long time or there very, um, well, whenever they first come in and you needed one of the year and I put put a confident second eyes come out in 24 to 48 hours, and you also want to prescribe them out some maintenance flutes on a maintenance weird for a person with faster and dried us that nothing will happen in my leader of saline mist reporting the most of potassium over yet. Marsh, it was the maximum that you can give someone Passing day would be about 80 millimoles and be the absolute max of 30 kg. Example to you. You're working on a medical ward of pulling the word around. Your consult was gonna ask you to prescribe some fluids for Ms is full. She's a 50 year old lady and she's 50 kg, and she was admitted with Urosepsis. She's had a very poor oral intake on despite encouragement to take 500 miles yesterday there's an F one you might hold, so anyhow, so I've 100 mils for last thing. You might also be producing your and but it's also important to consider. But fluid you would give this suppression. So does anyone want me to something about what flu is that we give this, you know? No, that's okay, so just go normally any. So you don't think about her daily maintenance. So she's 50 kg, and if you think you need 30 millimoles of fluid killer sorry, 30 miles per kilogram. But I say it's been about about a liter of hops, her dealing influence. Now she only had 500 yesterday, so she's got a leader deficit from yesterday. So she's going to need about 2.5 liters today. so there'll be nothing all doing this, lady. The later of Saline's 40 millimoles off task the ovary it or just need to give her a leader of dextrose. She's got very pearl and ticks. You don't want her to develop a condition called Starvation ketosis, which is where we're all quite guilty of feeling everyone bit of saline and the Provera, and we also forget that they also need glucose to make sure you give someone the leader back of doctors of radars on the meter next requirement, you can get 500 mils they over in hours or four hours for fluid. Her oral intake may increase within the next couple of days, where she might have more thirst today so she might be able to fill that remaining 500 mils just with her oral and tick. This lady needs 2.5 liters today, taken into a country leader deficit from yesterday. This is an example of myself identity, a strict back in the old straight sort of fto on one of their phones called me. I am on the ward's It's 58 year amount. He was admitted after being trampled black Harley. He had ribs. Grid five splenic laceration. He went for a nerve. Agents black splenectomy over me. He was gonna be day to postal on the nursing staff contacted the F one and they told their front of your life. But it was urgent. Steps 50 Mills hurts or 15 miles an hour for the last two years and then previously on 30. Certainly. So the F one went to see the patient, and they just increased the Reata current Viagra flu. It's instead of having ceiling. It's just a later bag of normal serve. No 10.9% sodium chloride prescribed over it. Ours on I am increased it to six already just to see if that would make a difference. Do your theater, the recontact, their form against it there. And I was like five miles an hour for the osteo or should significantly reduced your and I put it over the last four words. So I went with the F one and we reviewed the patient on. He was technically very dehydrated. It's it's still like 100 hand bring in mind. This not still like two days ago was 150 160 was his baseline. That's quite a significant jump for him. That's where it was 120. He was dressed stick, his mucus membranes were very dry, his lips were cracked and his tongue was very drying. He just look clinically horrendous. His comprehension times forward on a set of here, and I get up from five miles an hour for the past two years. Before that, I don't even 15 miles north. Jeannie had just just happened to be back, and whenever we went to review, his creatinine was 385 from a be a sign of a bit 60 on a Z F four was know 20th from a be a sign of 60. He had new past medical history, and that's that he's 50 year old man. He's not over manage stretch the imagination. He's previously clinically male. He's lost his spleens and you got a lot of intraoperative leading a smile. This man is in type of your make. Sure, essentially. So what we did for this patient may prescribe him. A leader of normal saline stopped me. Then give him the leader apartment to yours. And after that we asked for the bone there the 19 to repeat the uni after the second liter by going to prescribe any further foods following this, we also made a plan in that it's this patient needed. Have a year, and I could have better than 30 miles more and if every hour to contact someone if he wasn't eating right, because he would either need more fluids or potentially dialysis or need to go to I see whenever we come in that it's morning. We reviewed the patient and he ended up meeting 4.5 Need er additional flared on top of those two leaders we gave him just to get a year and I picked back up. But within two days, kidneys that covered on he was feeling a lot better and we managed to get home. But this is something that you will inevitably get cold. Here is an F one after you a range for the your life. It is the one thing Can g Teo am. We're going missing that someone's actually very own. Well, we're all guilty of just Raimondi you need but clinically on assessed tree and check the news chart and also very good for your bones start whenever you're going to do it, going to review some one so important points to remember and vision controller it all. But it's encouraging to do this. There's no need to get her through in the hospital. IV fluids if they've got simple chest infection but couldn't get them home because it was two o'clock in the morning in their age 80 they don't need to like flutes and little patients need fluids running in over. And I can set before yes, your hospital, because they're probably gonna be sick. But most people don't get fluids overnight on you think about it. You're not gonna have to turn it into your overnights about everyone meats and rolling in overnight. It's important if you're cold, to see someone to o'clock in the morning and say that man inside because, um, I just read the word. Her note's just establish If there is a plan for fluids, you know a patient with severe pancreatitis, the order and you could say they want a minimum 48 hours of food today. Name Let's say they only had two leaders IV fluids. The one he managed to drink 800 knows they're gonna need an extra 1200 miles to meet that part of the four liters. So they're gonna need a job I like overnight. And make sure you monitor the urine like, but if it's gonna start to drop off going, assassination and then if someone you're not it is starting to struggle. First thing, you should just close the catheter just to make sure it isn't there. Some kink in the catheter achieving You also get a sense of someone's M pinnacle sort of fluid status, but the color of your urine. It's very door concentrated and orange. They're quite dehydrated, and so they're going to be a bit more fluid to smoke again, some of it if anyone's ever been on the stroke before. Um, and I just like to approach some of the ups we find where you smoke for surviving F one blocker, Doctor, Fantastic Foundation doctor is sent us to go out. It's something you can look out whenever you're going to see. Someone is quite unwell. It has every scenario. You could have possibly be cold treat just things to think about when you're either delirious work up in the morning. You have a true, it's going on or you've just had, um I'm drunk and you've been You've got seven people after one C and you forgot what you do for someone with a bit of chest pain. Michael got. It's very good for dieting, obviously, um, infections without the miralax to give people on if they're penicillin, allergic or allergic to something else. With the old term different be and one of the machines lungs will be induction, and it has all the emergency possibly need for the hospital. And all the big numbers are moving normally. We need to contact someone, so thank you very much. We'll be that was useful. 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And please feel free to ask why I'll be here for the next couple of minutes. And thank you very much for treating it on the That was useful for you. Nice. That was great. Thanks. No.