Title: Does My Patient Need More Fluids?<br/>Author: Haney Mallemat<br/><a href='http://umem.org/profiles/faculty/785/'>[Click to email author]</a><hr/><ul style="list-style-type:square;">
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                        <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Only 50% of hemodynamically unstable patients will improve their hemodynamics in response to a fluid bolus. However, because excessive fluid administration can lead to organ edema and dysfunction, it is important to give hemodynamically unstable patients only the necessary amount of fluids to improve their hemodynamics.</span></span></p>
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                        <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">There are two general categories of assessing a patient's response to volume administration; static and dynamic assessments (see referenced article below):</span></span></p>
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                                        <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Static assessment (generally unreliable, but traditionally used):</span></span></p>
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                                                        <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Physical exam (dry mucus membranes, cool extremities, etc.)</span></span></p>
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                                                        <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Urine output</span></span></p>
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                                                        <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Blood pressure</span></span></p>
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                                                        <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Central venous pressure via central-line</span></span></p>
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                                        <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Dynamic assessment (more reliable but more labor intensive)</span></span></p>
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                                                        <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Pulse Pressure Variation</span></span></p>
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                                                        <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">IVC Distensibility Index</span></span></p>
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                                                        <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">End-expiratory occlusion test</span></span></p>
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                                                        <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Passive Leg-Raise</span></span></p>
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                        <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">There is no simple way to accurately determine the need for a fluid bolus however the integration of the techniques above can help the clinician make better decisions.</span></span></p>
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<fieldset><legend>References</legend>

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        <a href="http://www.hindawi.com/journals/crp/2012/531908/">Napoli,A.Physiologic and Clinical Principles behind Noninvasive <span style="font-size: 12px;">Resuscitation </span><span style="font-size: 12px;">Techniques and Cardiac Output Monitoring. Cardiol Res Pract. 2012</span></a></p>
<p style="text-align: center;">
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