Sir correct me if I am wrong, but to interpret any hemodynamic parameters for fluid RESPONSIVENESS, we should have a PRE-TEST PROBABILITY. On physical examination there was no tachycardia, no hypotension, no mucosal dryness, oliguria or prolonged capillary refill, and he also had edema - none of these suggest that the patient may benefit from IV fluids. PS I wrote the comment after pausing the video. But it was already addressed later on.
U r right fluids shoul be given only if he is going to benefit from them. As for clinical indicators mucosal dryness is a poor marker . And BP and HR can be n in fluid depleted patient . Low Stroke volume indicated by PP < 30 is more reflective than BP in such circumstances . CRT was not done neither lactate was available. Edema in dengue patients is due to capillary leakage and intravascular volume can be low IVC kissing even in a spontaneously breathing patient is indicative of fluid depletion intravascularly Only reason why some fluids could be given is that he had aki . Fluids would improve renal perfusion and prevent worsening
I agree sir. What I know is that I should know 3 things before I start fluid boluses (1) A Pre test probability for a fluid challenge- why should I even consider giving fluids to a given patient. (2) Fluid tolerance - Whether the patient can take a fluid bolus even if he seems to require it. (3)Fluid responsiveness. As you rightly pointed out, CRT was not performed, lactate was not available and anyhow whether or not lactate levels would indicate hypoperfusion due to fluid depletion in this case with a bad AKI is questionable, and also we didn't have an Art Line to use other dynamic parameters of fluid responsiveness. IVC collapsability in a hyperventilating, not intubated patient is difficult to assess as the IVC would keep moving in and out of the field. Even if measured correctly, we might be doing more harm than not if we keep bolusing the patient with isotonic fluids who has leaky capillaries leading to anasarca and MODS. What is your take on IV Albumin in this case?
There is no primary indication for albumin in dengue or in this pt. Albumin is used for DSS .I would just give him maintainanence fluid for adequate renal perfusion
![ตีสิบเดย์ [FULL] | ครอบครัวสะท้านทุ่ง "นางบี & อ้ายสติ๊ก"](http://i.ytimg.com/vi/A1rhYcxxNtA/mqdefault.jpg)
Excellent
😊
Sir correct me if I am wrong, but to interpret any hemodynamic parameters for fluid RESPONSIVENESS, we should have a PRE-TEST PROBABILITY. On physical examination there was no tachycardia, no hypotension, no mucosal dryness, oliguria or prolonged capillary refill, and he also had edema - none of these suggest that the patient may benefit from IV fluids.
PS
I wrote the comment after pausing the video. But it was already addressed later on.
U r right fluids shoul be given only if he is going to benefit from them.
As for clinical indicators mucosal dryness is a poor marker . And BP and HR can be n in fluid depleted patient . Low Stroke volume indicated by PP < 30 is more reflective than BP in such circumstances . CRT was not done neither lactate was available. Edema in dengue patients is due to capillary leakage and intravascular volume can be low
IVC kissing even in a spontaneously breathing patient is indicative of fluid depletion intravascularly
Only reason why some fluids could be given is that he had aki . Fluids would improve renal perfusion and prevent worsening
I agree sir. What I know is that I should know 3 things before I start fluid boluses
(1) A Pre test probability for a fluid challenge- why should I even consider giving fluids to a given patient.
(2) Fluid tolerance - Whether the patient can take a fluid bolus even if he seems to require it.
(3)Fluid responsiveness.
As you rightly pointed out, CRT was not performed, lactate was not available and anyhow whether or not lactate levels would indicate hypoperfusion due to fluid depletion in this case with a bad AKI is questionable, and also we didn't have an Art Line to use other dynamic parameters of fluid responsiveness.
IVC collapsability in a hyperventilating, not intubated patient is difficult to assess as the IVC would keep moving in and out of the field.
Even if measured correctly, we might be doing more harm than not if we keep bolusing the patient with isotonic fluids who has leaky capillaries leading to anasarca and MODS.
What is your take on IV Albumin in this case?
There is no primary indication for albumin in dengue or in this pt. Albumin is used for DSS .I would just give him maintainanence fluid for adequate renal perfusion
papilloedema on fundoscopy
Pappiledema is not always there with raised ict
@@youngindiaintensivist7709 yes