QuestionSBA
QuestionChoice
The patient is in net negative fluid balance and acutely hypotensive. Slow fluid replacement is not an appropriate response to this situation
33976
b
1L 0.9% normal saline over 4 hours
QuestionChoice
The patient is in net negative fluid balance and acutely hypotensive, which may be being exacerbated by beta-blockers and a blunted sympathetic response. A fluid challenge should be initiated and the blood pressure response carefully monitored
33975
a
500ml 0.9% normal saline over 15 minutes
QuestionChoice
Although it is increasingly becoming more popular as a maintenance fluid, dextro-saline has limited use as a plasma expander due to its high dextrose concentration and tendency to redistribute
33978
d
500ml 0.45% saline/4% dextrose over 15 minutes
QuestionChoice
5% dextrose is generally not used as a plasma expander as it redistributes quickly across all fluid compartments
33977
c
1L 5% dextrose over 1 hour
QuestionChoice
A balanced crystalloid is a good option for fluid resuscitation. It should be administered far more rapidly than over 1 hour for its effects to be maximised
33979
e
1L Hartmann’s solution over 1 hour
QuestionComment
Easy
Murtaza said we could have got it, so no arguing
37990
User
subscriber
Acute Myopathy
QuestionComment
The above was approved and authorised in the Nomani Residence
37991
User
subscriber
Acute Myopathy
QuestionComment
Is Hartmann's preferred for resuscitation post-op? 
59658
User
subscriber
Recessive Dominant
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2739
Negative net fluid balance post-operatively
Topic
13
Neurosurgery
6806
Case Presentation: A 36 year old man is recovering on the high dependency unit following emergency repair of a proximal aortic dissection. **PH** Marfan syndrome. **DH** atenolol hydrochloride 50mg PO OD, co-codamol 8/500mg PO QDS.


**O/E**

Drowsy but maintaining own airway. HR 64, RR 21, BP 95/56, O2 97% 2L NC, Temperature 37.4°C. Peripheries cool, CRT 4s. HS I + II + 0. Midline sternotomy dressing intact, 3x Jackson Pratt drains collecting serosanguinous fluid. Oral mucous membranes appear dry, skin turgor normal.

Fluids prescribed: 1L 5% dextrose with 40mmol K over 10h, 1L 0.9% normal saline over 10h, 250ml 5% dextrose with 20mmol K over 4h

Urine output over last 24h = 1.3L

Surgical drain output over last 24h = 1.5L

Question: Select the most appropriate management at this stage.
a