machadita 1,447 Views
Joined: Oct 9, '12;
Posts: 2 (0% Liked)
Are you going with WTW?
I spent six weeks in Dar es Salaam on placement in their national referral hospital. Best experience of my life.
fluid overloading a patient in heart failure would defeat the purpose of pumping with fluids to increase volume in the vascular space. The reason for this is that the patients heart is not strong enough to handle pumping all that excess fluid to the rest of the body and the fluid would end up backing up into the lungs as Labrynth stated above. This would likely cause a flash pulmonary edema and would make the patients outcome worse. Also pumping with fluids could also dilute the hgb portion even further resulting in a low lab result. A blood transfusion at a slow rate would address the low hgb without putting the CHF patient at risk for fluid overload
Ask yourself what would happen if you gave him a bolus of 500 or 1000 ml of NS and then he received 2-4 units of blood. He is in heart failure right? Where will the fluid end up? In his lungs then it wont matter what his H&H is because he will have ineffective gas exchange and respiratory distress not to mention the increased load on the heart. Also in his assessment is he peeing? If you are getting 30 ml urine an hour his kidneys are perfusing well and he has time to wait for the blood.
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