Day two and I'm getting the hang of prescribing fluids. Essentially working on the principle that low sodium => normal saline, high sodium => dextrose (but make sure they have some saline at some point, and some potassium at some point) and low potassium => haartman's. If patient on certain drug regime that needs certain fluids, refer to nurses. Maintenance fluids in fit young patient 8 hourly, fluids in small, frail patient with CCF 12-18 hourly. If 1L bag finishes in the middle of the night write up another bag so night team arent bothered by unnecessary bleeping. Seniors, feel free to comment with additional advice.
Had episode of SVT upon spotting the "shit's above the seagull sign" (as in, pulse rate higher than systolic BP) on a little old lady's chart. Informed registrar who suggested I assess her for fluid balance. Wasnt quite sure what this meant but went to examine her. She was GCS 15 and looked well. Heart rate (at palpable radial pulse) was not as high as obs suggested. BP was not as low as obs suggested. BP did not decrease on standing (in fact in increased which is good going for an 80 year old). Tongue looked dry and skin turgor was decreased, cap refill was 3 secs. So she wasn't shocked but needed fluids. My heart rate returned to normal.
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