2012-12-21

Anaesthesia & Critical Care get along with Basic Science

In the situation that you have to make a decision to correct your patient's haemodynamics instability, you must gather your patient's details about what went wrong and what you can intervene. Fluid resuscitation is one intervention that is usually performed in the face of severe hypotension. It is the centre of therapy in the early phase of shock management, but in the later phase it may not work in all patients.

You have to assess your patient's cardiac function where your patient's cardiac contractility is by the applying the data you can evaluate on the Frank-Starling cardiac function curve to see where it is. If it lies in the steep portion of this curve, it would mean that your patient can respond to have augmented cardiac output or venous return by just simply fluid loading to increase right atrial pressure or passive leg raising. On the figure below, if you can shift your patient's status from 1 to 2 (right shift), it is safe to proceed your fluid administration, and your patient responds so well with that.


This figure can be accessed from Chest, it is nearly 5 years old, but is an important landmark that you should not miss so that you will not give your patient too much fluid, and keep in mind "less is More" concepts.

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