The intrinsic beauty of human physiology >> Beauty of the ICU >> “Art” in the ICU >>(CO = HR x ??)

p1090783

“In a Nutshell” :  the beauty of human physiology

Although this is just a swishing and sloshing of stuff in the ICU, there is intricate beauty in this clip … just activate the “replay” function of the movie player your PC uses.

The urine output flow is demonstrated in the clear urine “moving along” in the urimeter set.

The blood sloshing around represents the collection moving around to the beat of the HR.

Between these 2 fluid volumes sloshing around, is the implied requisite stroke volume per heart beat.

 

2 min Evaluation – Urimeter – darker yellow – 10 seconds to reach a conclusion

uryll

2 min Evaluation – Urimeter = darker yellow – 10 seconds to reach a conclusion

The quick explanation :

Situation :    urine = darker yellow.

Background :    dehydrated / intravascularly depleted.

Action :    cautious intravascular volume repletion.

Recommendation :     Alveolar recruitment technique (ART).

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The “long winded” explanation :

S-B-A-R format reporting – quick reporting format for handoff from one healthcare professional to another.

A lot of this presentation is conjecture … but time and experience has proven correct 99 out of 100 times.

Darker yellow urine is a likely indicator that your patient is intravascularly depleted to some extent.

A “passive leg raise” maneuver (MORE TO FOLLOW AT A LATER DATE) will provide additional information as to the value of  intravascular volume repletion.

If the patient’s systemic blood pressure / cardiac output improve significantly, a 500ml NSS repletion regimen is
likely going to improve outcomes.

Whenever fluid is repleted, alveolar should be protected via ART (alveolar recruitment technique) to avoid unintended
migration of NSS into the pulmonary interstitium and unintended alveolar compression (= compressive atelectasis).

 

2 min Evaluation – Urimeter = clear – 10 seconds to reach a conclusion

urmtrii

The quick explanation :

Situation :    urine = clear.

Background :    fluid overloaded.

Action :    forced diuresis.

Recommendation :     Alveolar recruitment technique (ART).

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The “long winded” explanation :

S-B-A-R format reporting – quick reporting format for handoff from one healthcare professional to another.

A lot of this presentation is conjecture … but time and experience has proven correct 99 out of 100 times.

Clear – forced diuresis (Lasix) – fluid overloaded – increased CVP .

Fluid overloaded due to a transient hypotensive crisis.

The fluid is coursing its way thru the vasculature and some of that fluid is finding its way into the pulmonary parenchyma.

Use Alveolar Recruitment Technique (ART) to mitigate the effects of rogue intravascular fluid … finding its way to the extravascular space (pulmonary interstitium.