Intravenous Fluid Therapy During Anaesthesia

Intravenous Fluid Therapy During Anaesthesia INTRAVENOUS FLUID THERAPY DURING ANESTHESIA Water, Electrolytes, Glucose requirement, Disposition The intravascular compartment consists of blood cells, colloids, and solutes. Each one of them plays a specific role in the homeostasis. In the perioperative period there are losses and shifts of ECF between compartments. Injury, surgery, endocrine pathology contribute to those shifts and ultimately influence outcome. It is generally accepted that the total body water of a 70kg adult patient is approximately 60-70% of the weight and approximately two-thirds of it is intracellular. The focus of this chapter is the intravascular volume which consists of extracellular volume, plasma, and intracellular volume attributable to erythrocytes, leukocytes, platelets. The plasma, constituting approximately 3 L, consists of inorganic ions, albumin and small molecules. The inorganic ions are found on both sides of the cellular membranes and their concentration is maintained due to an energy consuming process. The Na+/K+ ATP-dependent pump maintains a higher N+ and Cl concentration in the extracellular space while K+ concentration is higher intracellularly. The albumin and other larger molecules are kept in the intravascular compartment by the endothelium cells due to their size. Smaller molecules, however, can cross freely this barrier. The endothelium cells and thus the barrier they provide can be disrupted by injury, surgery, or inflammatory processes. The result Is a disruption of homeostasis with significant deleterious effects on the body. Additionally, disease states can cause disruption of the inorganic ion homeostasis and leading to fluids shifts between compartments leading to edema, poor perfusion, lactate buildup, poor excretion of harmfu l metabolites and causing additional injury. Starlings Equation underscores the important forces (hydrostatic and oncotic) affecting fluid distribution between capillary and interstitial space: Jv = Kf [(Pc Pi) à Ã‚ ­ (Ï€c Ï€i)] Jv net filtration or net fluid movement Kf filtration coefficient Pc and Pi the hydrostatic pressures in the capillaries and interstitial space respectively à Ã‚ ¬ reflection coefficient Ï€c and Ï€i capillary and interstitial oncotic pressure The natural driving force and thus fluid movement is from capillary to interstitial space, where the excess fluid is cleared by the lymphatics. Diseases and trauma, whether due to surgery or otherwise induced and leading to inflammation and release of toxic substrates, disrupts the balance and the function of the endothelium and reducing the reflection coefficient. The increased permeability can lead to changes in the interstitial fluid composition which changes the oncotic pressure difference leading to further extravasation of fluid and resulting in tissue edema. This edema compromises local perfusion and accumulation of toxic byproducts causing a vicious cycle and ultimately death. The osmotic pressure is due to semipermeable membranes. Solutes which freely traverse a membrane dont build an osmotic pressure gradient across the membrane. Glucose is present in the intracellular fluid and serves to provide energy substrate. It is regulated through insulin and maintained at a level between 70 and 90 mmol/L in healthy adults. Increase in the glucose concentration can change the osmotic pressure across the endothelium and cause fluid shifts leading to Our goal as anesthesiologist is to maintain the intravascular compartment and assure adequate delivery of oxygen and nutrients to the organs while maintain good clearance of metabolic byproducts. The following classification of the perioperatively used fluids is ubiquitous: crystalloids and colloids. Crystalloids with ionic solution and osmolality close to that of plasma are deemed balanced solutions. The glucose is used to provide energy substrate and used in hypoglycemic patients or in combination with insulin. Once the glucose is metabolized, the reminder of the free water can be easily distributed along all compartments. Colloids consist of dissolved large molecular substances. They are generally described by their molecular weight or MWw. This property contributes to the oncotic pressure created intravascularly with intact endothelium and glycocalyx. Naturally occurring colloids encompass albumin, immunoglobulins, fresh frozen plasma, and plasma protein fraction. Semisynthetic ones are: gelatins, dextrans, and hydroxyethyl starches (HES). Semisynthetic and naturally occurring colloids have raised the concern of viral and prion transmission, particularly those from bovine origin. While most of the colloids have variable size of molecules, human albumin is more uniform. Gelatins are bovine collagen derivatives. Some preparations can contain Ca or other inorganic ions and those need to be taken into consideration. Dextrans are biosynthesized sucrose derivatives. They are best described by their molecular weight, i.e. Dextran 40 has a molecular size of 40,000 Daltons (Da) and Dextran 70 70,000 Da. Their clearance is highly dependent on their molecular size with smaller molecules freely filtered through the renal glomerulum and larger sizes are metabolized by the reticular endothelial system first and then excreted through the gut. Hetastarches are derivatives of amylopectine. They are divided into high-molecular weight, medium molecular weight and low molecular weight. They can be dissolved into normal saline or balanced solution. All semisynthetic colloids are known to exert an effect on kidneys and coagulation. Thus, there is a maximum dose recommended by the manufacturers. FluidRequirementsandFluidDeficitCalculations Normal Salinevs.LactatedRingersvs. Plasmalytevs.D5W

Memorable Moments with My Sibling Essay

A relationship with a sibling is everlasting: last longer than the bond with a spouse, parent, or friend. Have you ever thought about the times you have spent with your siblings? Those are memorable moments that I would always cherish. The bond with my sibling taught me many lessons in life. My childhood relationship with my sibling has changed since I became an adult. The communication and the people we associate with had changed between us. During any oppression we had gone through, our love still remains the same. Since adolescence my younger sister, Genesis, and I were inseparable. We were like the cartoon characters Tom and Jerry. Genesis used to tell me everything; I was like her secret diary. For example, Genesis would come home to our two bedroom apartment from Attucks Middle school and used to tell me how wonderful or miserable her day went. When she had a delightful day coming home would be satisfying and a little annoying for me. She would tell me how stunning a boy was in her class and was disturbing for me. I didn’t want to hear about her Prince Charming. However, you could tell when she had a dreadful day, she would come home slamming the front door and leaving an echo in the vague hallway. She would run to our cluttered room and jump on her twin size bed. Walking towards her I could hear her calling my name â€Å"Eric†. I said â€Å"Genesis are you feeling ok, what’s wrong? † Genesis said â€Å"There is a boy in my math class calling me a nerd. † I would then comfort her by giving her a hug and tell her not  to worry. You know what they call nerds in the future? Boss! † I said. Genesis always felt safe around me I was there to protect her from any harm like a father figure. However, I joined the United States Army; our molded relationship became more distant. I would only see her physically when important events occurred. For instance, I saw her three months after I graduated from basic training in Fort Jackson, South Carolina. Communicating through Skype and the six hours difference between Germany and Florida makes it difficult to talk my sister. Our daily conversation about are experiences since we were younger became weekly or monthly as we matured. Overall, age and the distance between us had caused our connection to fade. When I was younger I used to consider Genesis annoying, because of her eager desire to hang out with my friends living around Coolidge Street, Florida. For example, when I got invited to house parties, Genesis assumed she was automatically invited. Of course she was wrong; a house full of 18 year old teenagers partying had no business interacting with a 14 year old girl. As I got older Genesis became a young adult; the age difference didn’t seem to matter anymore. Now that Genesis became mentally matured, she is acceptable to be in my group of friends. A couple of my friends spend time with my sister watching movies and taking her to different vicinities. My sister and friends took a trip to Rapids Water Park in West Palm Beach, Florida. They enjoyed having a blast in the refreshing pool and the water coasters. In brief, since my sister and I share common friends, we socialize more than the past. The love between my sister and I will remain the same. Even through any tribulation that had occurred toward us, we would always be there for each other. For example, my sister would try to hide the fact that she had a fear of crossing the road every morning to the bus stop; I had an intuition that she was, so every morning at 5 o’clock I would walk my sister five blocks and cross  the street with her to the bus stop, sacrificing two hours of my sleep to ensure that she would arrive safely and according to schedule. Genesis is currently nineteen years old, she had two car accidents and is going through some hardships because she is unemployed and her insurance bill went up. I manage to help her financially until she’s on her feet. Vice versa she also helps motivate me with her encouraging words and accomplishments. She graduated top ten percent of her graduating class and did early admissions while in high school. I was discouraged to enroll into University of Maryland University College while being in the military; by her achievements I was inspired to enroll into UMUC and take a writing 101s course. As you can see, during any discomfort Genesis and I will go through, we will always take care of each other. In conclusion, since childhood my relationship with my sister has changed, our communication had faded over time. Some of the friends we spend time with, are the same. When we had gone through any problems, we would help each other. Why is our bond so strong? We had been there for each other our whole life. Even the distance between us, would never break our love for one another.

Impact of E-Learning in Secondary Schools Students

The development of technology and the Internet all over the world during the last decade has enabled new educational delivery methods like E-learning. It is the use of technology to enable people to learn anytime and anywhere. E-learning applications and processes include Web-based learning, computer-based learning, virtual education opportunities and digital collaboration. stakeholders at different levels, such as researcher, practitioners and institutions understand the value of e-learning [Kira 2009], thus countries all over the world has adapted to this new delivery method, and Fiji as one of the developing countries has also joined them.The Universities in Fiji have already started using this method and by 2014 Fiji hopes to implement this education method in around 20 secondary school. As online education gains in popularity, it becomes more important to recognize the inherent advantages and disadvantages offered by this medium[Richard Hauser 2012]. Timothy Rodgers [2008] also stated that as the use of e-learning is becoming more and more widespread in higher education it has become increasingly important to examine the impact that this teaching style has on student performance.There have been a number of researches conducted to prove numerous advantages of E-learning. Firstly, E-learning is cost effective, for example, there are no travel costs. Melissa et al [2011]stated, access to online training is cost effective. Higgins [2012] also supported that by stating that e-learning can be effective for students as they do not need to travel and efficient in terms of time. Majority of the learners being middle aged education professionals and keen on professional development could take course that are offered through e-learning since it does not impinge upon their work times. Shikha Raturi 2011] Secondly, E-learning has Flexibility, Accessibility, and Convenience. Here the Learners can proceed through a training program at their own pace and at their own plac e. They can also access the e-Learning course at any time and only as much as they need. The rapid advance of web technology has enable universities to reach out and educate students across time and space barrier [Shu-Sheng Liaw 2008]. Higgins [2012] also supported the claim by stating that e-learning can provide flexibility in terms of time and place. Mary F.Fortune [2011] states in her research that eLearning is also convenient to learners who have problem with communication skills. Thirdly, E-learning has a lot of exchange of ideas and sharing of knowledge. Higgins [2012] specified that e-learning enhances the efficiency of access of knowledge. Shu-Sheng Liaw [2008] identified that eLearning assists learners in collaborative learning, exchanging ideas and sharing knowledge. The author also stated that in web based system, learners are encourage to exchange ideas, share perspectives, and use previous knowledge in order to decide on the best solution for the problem.He also specifi ed that knowledge sharing also enhances better teaching and learning. Although there are a lot of positives about ELearning, there are many disadvantages of E-Learning schools, and disadvantages with the ELearning process. The first issue is skills are required for the user to be able to take advantage of the E-learning. That is basic computer knowledge is require for E-learning. Kira [2009] stated in his paper that fifty percent of adults, including the first year University students, have some sort of computer related phobia.Kushir [2009] discussed in the paper that lack of certain skills or experience might put one at a disadvantage when compared to the experienced once. Lack of operational knowledge and of capabilities narrowed the options of the users in E-learning. [Falloon 2011] Next issue with E- learning is isolation of learners. As stated by Higgins [2012] learners might suffer from isolation and lack of direct social interaction. Further to that point Falloon [2011] added that learners studying at a distance can still suffer from a sense of isolation and disconnect which can adversely affect their performance.Ease of use of E-learning system is another issue that affects the learners. This is when the learning system interface is not user friendly; learners have problems using the system. Kira [2009] indicated in her work that computer anxiety was influenced by how users perceive ease of use of an information system. Shu-Sheng Liaw [2008] also added to ease of the system as user acceptance towards the system, where learners are concerned about the operating methods and functions. Information Overload is another issue of E-learning.Students reported feeling overload in the eLearning courses. [Kushir 2009]. His work also stated that some online environments are unnecessarily cluttered with irrelevant stimuli and information or the way in which the relevant information is organized affects how students learn. From the works of the above researchers it can be known that for any popular system there are positive and negative impacts depending on a range of factors such as different kinds of user, different locations of the system, different choice of users and so on.And as Fiji has recently stepped into this technological advancement of E-learning it will have its own set advantages and disadvantages. However, from the literature review the gap in E-learning was identified as equal Accessibility of the phenomenon by the populace of both rural and urban centers. It was also identified that computer Literacy of participants influenced their mode of learning.

Over-Population and Earth Processes essays

Over-Population and Earth Processes essays The Earth is facing two major issues with regards to its carrying capacity and over-population. Society continues to populate the Earth while the average life expectancy continues to rise. The Earth can only support a set amount of humans before its resources are used up. As well as the Earths resources becoming exhausted, there is also the issue of the high human population polluting the water to the point that some water reserves are not safe for consumption. In 1998 the world population reached 5.9 billion people according to the United States Census Bureau.1 These population figures signify that the world population has at least doubled since 1950, at which time the world population was only 2.6 billion people.1 The Earths population still continues to rise and has already reached the 6 billion people mark. If these population figures remain constant, the Earth will be well over its carrying capacity. With the continuing rise in world population comes the issue of the Earths resources becoming exhausted. An example of these exhausting of resources is oil. Society is already facing the issue of the Earths oil reserves being spent. The economic law of demand states The principle that, other things equal, an increase in a products price will reduce the quantity of it demanded; and conversely for a decrease in price.2 Because the price of oil has increased drastically over the last three years, the amount of oil that society uses has somewhat decreased because consumers are identifying the issue of oil consumption and are now buying more fuel-efficient vehicles.3 According to the economic law of demand, as more consumers switch to more fuel-efficient vehicles, the price of oil will come down again because the demand for oil will diminish and our oil reserves will remain stable. However, our oil reserves will only remain stable if more of society changes their lifestyles to accom m...

3 Lessons Freelancers Learn from... Bears

3 Lessons Freelancers Learn from... Bears Things that are great about being a bear: You get a diet rich in fish, you’re big enough that most predators don’t bother you, you don’t have to have a LinkedIn Profile, and when you want to go sleep in cave for weeks at a time, nobody thinks it’s weird. Fortunately we’re not just doomed to a life as sad hairless bear-wannabes. There are things freelancers can learn from bears when it comes to managing our work-life, as assembled by Chris over at Rags to Reasonable.Lesson 1: Hibernation ModeUnless you’ve landed a really plum long-term contract or three, odds are your workstream ebbs and flows (or sometimes even dries up entirely). This means you have to know how to match your variable expenses to your variable income- make sure you know how to get your operating costs low and manageable enough to allow even your â€Å"hibernation wages† to last you until your next big paycheck.Lesson 2: Go Where the Food IsThis lesson is both obvious a nd frustrating when you’re starting out and taking every single job that comes your way. Some of them may not be as lucrative as you wanted or as relevant to your overall goals as you hoped. Still,  you take them and accept what the market has to offer since you don’t know if there will be food (i.e. work) if you hold out for something closer to your experience.Lesson 3: Filling Your Fat StoresA positive and negative of freelancing is that when it rains it pours, if you’re paid by the project and not hourly. This means you may work for a while in obscurity and then (sometimes months later!) are  rewarded with a significant check for a large portion of your work.The most valuable tip I took away from Chris’ bear-advice was to remember that check is  not disposable income; it’s not leftover, it’s not actually a reliable, regular paycheck. Make it last as long as possible by being savvy with your spending and strategic with your saving.If You’re Freelancing, Have a Plan For Your â€Å"Hibernation† SeasonIf You’re Freelancing, Have a Plan For Your â€Å"Hibernation† Season  Read More at Rags to Reasonable

The Stone Angel Hagars objective moment Essay Example | Topics and Well Written Essays - 250 words

The Stone Angel Hagars objective moment - Essay Example On the one hand, her fighting spirit is a great attribute in her life, and on the other hand, her pride in her early years has been a problem for her while managing the changes that take place in course of a life time. Looking at the life of Hagar Shipley in this book, the most objective moment in her life was the one when a stubborn and proud Hagar is broken at the hands of poverty. The moment where she realizes that she is no more the all important wealthy person but just another woman who does not have any money, is the most objective moment. In this moment, Hagar who has been stubborn all her life and whose heart has been full of pride, has gone back to the â€Å"Curries† General store. This was the store once opened by her father and thus she was confident she can get a credit from this store. However, by the time she meets the manager, instead of requesting a credit, she just begs for a loaf, to feed her kids and herself. She was dressed poorly as she could not afford an ything fancier. The proud stubborn Hagar Shipley realizes her life has changed; she’s not the same fancy wealthy person she once was with her family. She finally sees herself for the lower class old lady she has become. References: Laurence, Margaret.

Journal article critique Essay Example | Topics and Well Written Essays - 500 words

Journal article critique - Essay Example Distribution of leadership would serve motivate the teaching staff making them to go beyond their mandate. The benefits of this distribution of leadership responsibilities would consequently trickle down to students. I found the idea that leadership is moral activity that should be creative and transformative in positively influencing the social and personal aspects of students’ lives insightful. This is important because it shows that effective leadership should not be based on opinion but duty (Rhodes & Brundrett, 2009). The idea of incorporating all stakeholders in influencing positive and improving schools and student behavior is a tested idea and it is effective. Leaving other stakeholders such as parents and students from leadership locks out the contribution of these stakeholders and this can slow the achievement of the goal of school improvement. The authors of this article explain that leadership that factors in student voice helps to not only improve a school academically and imparts responsible and active citizenship in students. I find this idea important because schools are supposed to have a holistic impact on students not just academically. I agree with these authors when they contend that leadership positions in schools are still highly engendered and this need to be changed. This idea is important because it would help tap women’s talent in improving schools (Rhodes & Brundrett, 2009). The idea that leadership development happens effectively on the job is important because it extends leadership development beyond leadership training programs. The idea to create a learning community as a strategy to enhance adaptability to change and improve students’ outcomes is noteworthy. This is because, many organizations are increasingly emphasizing the role of a learning environment in facilitating improvements