2.3 REGIONAL LEGAL INSTRUMENTS Costa Rica is party to the Organization of American States OAS ; , which was created in 1948. The OAS brings together 21 countries of the Western hemisphere to strengthen cooperation and advance common interests. It is the region's premier forum for multilateral dialogue and concerted action. Building on this foundation, the OAS works to promote good governance, strengthen human rights, foster peace and security, expand trade, and address the complex problems caused by poverty, drugs and corruption6. The OAS American Declaration of the Rights and Duties of Man Approved by the Ninth International Conference of American States, Bogot, Colombia, 1948 The OAS B-32: The American Convention on Human Rights "Pact of San Jos, Costa Rica" ratified on 8 April 1970 The OAS A-49: Convention to Prevent and Punish the Acts of Terrorism Taking the Forms of Crimes against Persons and Related Extortion that are of International Significance ratified on 16 October 1973.

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Fluid challenge in patients with suspected hypovolemia suspected inadequate arterial circulation ; may be given at a rate of 5001000 ml of crystalloids or 300500 ml of colloids over 30 min and repeated based on response increase in blood pressure and urine output ; and tolerance evidence of intravascular volume overload ; . Grade E. Rationale. Fluid challenge must be clearly separated from an increase in maintenance fluid administration. Fluid challenge is a term used to describe the initial volume expansion period in which the response of the patient to fluid administration is carefully evaluated. During this process large amounts of fluids may be administered over a short period of time under close monitoring to evaluate the patient's response and avoid the development of pulmonary edema. The degree of intravascular volume deficit in patients with severe sepsis varies. 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