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Mel grant

Mel grant

ICU
New New Nurse
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Mel grant specializes in ICU.

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  1. I am fairly new to the ICU and needs some help with fluids. I had a pt who was in HHS but also CHF and COPD. Pt was in obvious resp distress, unable to lie back even slightly. States they have slept in a chair with their head on the kitchen table for the past few years and this is baseline for them. They were put on DKA protocol (do not know why) which is 4 liters of fluid and an insulin gtt along with Q1H BS and Q4H labs. I am concerned about the amount of fluid (normal saline) they got. Later in the shift they became hypotensive and were ordered another 1,000 ml normal saline bolus. CXR after the 4 liters did not show any pulmonary edema. My question is, is there a better fluid than normal saline? How do i prevent needing to intubate the patient? Would lasix defeat the purpose of the fluid boluses? What is the role of albumin for fluid resuscitation in CHF and HHS or DKA? Any help would be appreciated. Thank you
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