Okay, let's go to our volume expanders. Right? So we
identified that the patient's
blood pressure is low because we need to give the patient
volume. Right? Well, we
have some things that we can do for that. Okay, if we want
to increase our preload
in our pulmonary artery diastolic, we want to increase our
pressure is going in to
the left and right ventricle. We could start with
crystalloids. Your crystalloids are
going to be your normal saline and your Lactated Ringer's.
Now the primary job of this is to expand your circulatory
volume. It's going to increase
your CVP and your PAD. And we're usually going to use
isotonic solutions for this. Right?
Just keep in mind that hypotonic solutions can cause more
fluid to leave the vascular space.
So if you accidentally grab D5W or half NS and you start
thinking you're starting just normal saline, you actually
may drop your CVP
because that fluid is leaving the vasculature space and
going into the cells or the 3rd space.
And then keep in mind with Lactated Ringer's if it's used in
dysfunction it can cause a lactate accumulation so you may
increase your lactate level.
Our second volume expander is colloids. This is going to be
your Hespan and your albumin.
Right? So the primary job is to expand circulatory volume
again to increase our CVP and our PAD. Now, if we use
albumin, it's going to
increase our oncotic pressure and draw more fluid from the
compartment to the intravascular compartment. Now we have
albumins of 5%
and 25%, 5% is more of just a volume expander, doesn't
really affect the oncotic
pressure too much but if we're given 25% we really want to
the body to pull more
fluid into the intravascular space. Adverse effect of this
is hypervolemia so we get
too much volume into the vascular space. We may cause CHF
patients that have congestive heart failure and we can cause
because all that extra fluid is going to go on to the lungs.
Now, keep in mind
though if the patient is anemic and has a low hemoglobin or
we should always give red blood cells to administer rather
than colloids or crystalloids.