Junior doctor survival kit
Marios Hadjipavlou and coauthors provide some of the basic principles of fluid management and suggest a framework for managing a patient’s fluid balance
You are the foundation year 1 doctor on call at night in the emergency department when a 24 year old man is admitted with a stab wound in his groin and severe ongoing blood loss. His blood pressure is dropping and the patient becomes unresponsive. Once you have stemmed the flow of blood by applying direct pressure and provided oxygen, what intravenous fluid would you choose for resuscitation? How much would you give? And why?
As a house officer, it is essential to be able to assess a patient’s fluid status and make management plans.
The body of an average healthy adult comprises 60% water.1 Of this volume, about two thirds is intracellular fluid and one third is extracellular fluid, separated by the cell membrane. The extracellular fluid is further divided into plasma (intravascular compartment) (one third) and interstitial fluid (two thirds).1 Fluids within the extracellular compartment come into equilibrium