How much fluid bolus would you give this patient?
Junior doctor on call
Another short newsletter this week and I wanted to cover something important that I see coming up a lot. Some of you may know this, some of you may not.
Scenario:
You are bleeped to go see a patient in the cardiology ward who seems to be deteriorating. The nurses inform you that he was complaining of feeling uneasy a few minutes before and now he seems to be really unwell.
What are you doing first?
A. Fluid bolus STAT 500ml
B. A to E assessment
C. Contact senior cardiologist on ward ASAP
D. Check patients drug chart
E. Wait & Watch for a few minutes
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The correct answer is B.
This is something I learnt a few months ago and there possibly are a few people that still don’t know this but the first thing you should do when going to see any patient you have been bleeped for is the A to E assessment.
It makes sense because you going in order of things that could be most fatal to least. I.e A in A to E stands for airway and you first check if the airway is patent and that the patient is breathing before you worry about let’s say their sugar levels (which is something you check in the letter D) because the breathing will kill them first.. hopefully, that makes sense.
There is a lot of detail that goes into the A to E assessment, you check for many things, you fix them, you re-check them etc
You respond to the bleep in question 1, you go to the room, you do your A to E assessment and amongst other findings, you also discover that the patient has a BP reading of 85/55 and HR of 128
So which fluid are you giving this patient in the above scenario? (assume he has no comorbidity)
A. Saline STAT 500 ml over 5 - 15 minutes
B. Saline STAT 1 L over 15 - 25 minutes
C. Saline STAT 250 ml over 5 - 15 minutes
D. Dextrose 5% STAT 250 ml over 1 hour
E. Dextrose 10% STAT 500 ml over 30 minutes
You always want to give Saline 500ml stat over 5 - 15 minutes UNLESS there is a suspicion or confirmed diagnosis of heart failure.
Heart failure patients get Saline STAT 250 ml over 5 - 15 minutes.
Warning: You’d give 250 ml with caution and you’d be wary of giving a second dose too
(I’m about to go on on a 1 minute random talk about shock and fluid bolus - not sure why)
One of the common findings you will come across in A to E assessment when you get
to the letter C (Circulation) is low blood pressure.
You will ask a nurse or someone to get the BP reading for you and the HR and you will be told something like the patient has a BP of 85/50 or 90/60 etc.. basically hypotensive and their HR being high (tachycardia)… This should alert you to some kind of shock that this patient is going through.. remember, low BP, high HR = shock
At this stage, you need to give fluid bolus to bring the BP up.
(there any many reasons to why you should give fluid bolus, one of them is shock)
Here is the fluid resuscitation chart
Here is the full version:
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