have a couple questions regarding fluid overload. i had a patient a few weeks ago who had pancreatitis and earlier she satting 98 and feeling fine with 250cc/hr saline going. this was before my shift. when i assessed her, she had quite a few crackles and she was satting about 92. i wanted to turn down her fluids but the doc wanted to put her on o2. i did the latter and later her sats were 98 again and her crackles were gone.
my question is, she was young 35 with no cardiac hx. was i silly in worrying about fluid overload? it possibly just could have been atelectasic crackles from her being in bed so long. also, does supplemental 02 create enough pressure to push fluid back into the pulmonary vasculature should there be little fluid?
from my other experiences, it seems that crackles will be heard sometimes long before sats actually start dropping in cases of fluid overload. your thoughts? thanks again.
May 3, '04
Agree that your assessment skills are right on target. A patient with 250 cc/hr, hypoxia and crackles one would think "pulmonary edema". Kudos for calling the doc on that one.
Another thing besides what Janet mentioned above was what was the BUN and Cr.? Off topic story: I had a coworker of mine a while back get all upset over this "wet" patient. She called the doc and got lasix. As the charge nurse I went to assess the patient and to me it seemed like he had pneumonia, as he coughed up his secretions and was showing signs of dehydration, plus this patient was heplocked and taking poor p.o. (scarey nurse). Sure enough his BUN was in the range of dehyration.
Last edit by Tweety on May 4, '04
May 3, '04
Quote from heart queen
I think you did GREAT! I agree that CVP monitoring is especially helpful, drop a central line and transduce it.. but this patient was most likely on the floor, not even a tele unit... from what I've learned here on the BB, few tele units even are credentialed to transduce.
WHAT? You mean they don't have the CVP water manometers anymore?
I was going to say the "old-fashioned" CVP manometers, but I thought then I would REALLY be showing my age (50, LOL!) We used them routinely right through the '80s.
Yeah, nowadays we transduce CVP lines and look at the tracing on the datascope, but we still keep the water manometers around for the "older" anesthesiologists who prefer them...they really ARE older, like in their 60s...
Personal note to Zac--do you by chance work at Harbor View? Awesome, awesome, awesome trauma center--A "trauma center's" trauma center.
Or Virginia Mason?
Please don't say you work at Swedish...... :uhoh21:
Last edit by stevierae on May 3, '04