- * Monitor vital signs, orthostatic blood pressure, mental status, and urinary output
- * Monitor trends in hemodynamic parameters (e.g. CVP, PAP, PAWP) to assess patient's status and detect fluid deficits or excesses and to evaluate patitent's response to treament.
- * Volume expansion with administration of appropriate fluid to maintain blood pressure and cardiac output
- * Monitor for symptoms of respiratory failure (e.g. low PaO2, elevated PaCO2 levels, respiratory muscle fatigue) to plan respiratory interventions.
- * Monitor fluid status, including I/O
- * Monitor renal function (e.g. BUN, creatinine levels)
- * Provide O2 therapy and/or mechanical ventilation to maximize oxygenation and maintain SaO2 > 90%
- * Monitor blood glucose levels.
modified Trendenlenburg position
IVs with not only crystalloids but also colloids and/or blood products. Note: Lactated Ringers solution should be used cautiously because failing liver cannot convert lactate to bicarbonate leading to increased serum lactate levels
protect against fluid replacement hypothermia by warming fluid
fluid resuscitation in hypovolemic shock is initally calculated 3:1 rule (3ml of isotonic crystalloid for every 1ml of estimated blood loss)
dopamine (Intropin) can increase cardiac output; to treat hypotension; to increase urine output; increases renal perfusion, glomerular filtration rate, sodium excretion and urine output; inhibits insulin secretion
Vasopressin is an exogenous preparation of ADH; causes potent vasoconstriction leading to increased blood pressure without associated tachycardia and arrhytmias present by b-adrenergic stimulation
dobutamine causes vasodilation from beta2 stimulation which decreases afterload and improves myocardial contraction without massive increases in hearte rate and blood pressure; hypotension may occur if vasodilation is not offset by an increase in cardiac output.
Vasodilators (e.g. nitroglycerin, nitroprusside) are a type of vasoactive drugs used clinically to treat hypertension, prodiced controlled hypotension, and decrease left ventricular (systemic) myocardial workload; decrease systemic BP by decreasing systemic vascular resistance, venous return and cardiac output. Nitroprusside leads to a risk of cyanide toxicity; need to replace Q24h