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Senior - Surgery 1 > 1 - IV Fluids > Flashcards

1 - IV Fluids Flashcards

1
Q

Normal daily fluid intake requirement:

A

2 liters (75% from H2O, 25% extracted from food)

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2
Q

Urine output (UOP) should be estimated at _____ for fluid resuscitation

A

1ml/kg/hr

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3
Q

UOP should be how much per 24 hrs?

A

Approximately 1 liter

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4
Q

Other sources of water loss (besides peeing)

A

600ml/24hrs

Skin (75%)

Lungs (25%)

Increases significantly with fever and critical illness

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5
Q

Normal fluid loss via GI tract:

A

250ml/24hrs

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6
Q

Oral rehydration solution (ORS) consists mostly of:

A

WATER - SUGAR - SALT in a standard ratio

2tbsp sugar
1/2 tsp salt
1 liter water

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7
Q

Examples of patients needing IV hydration

A

Inadequate PO intake

Peri-operative patients (NPO)

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8
Q

IV rehydration is ok for how long? After that, what do you do?

A

Up to one week

If needed longer, consider enteral G-tube or J-tube, total parenteral nutrition (TPN)

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9
Q

LR fluid is

A

Lactated ringers

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10
Q

NS fluid is

A

Normal saline (0.9% NaCl)

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11
Q

P-Lyte fluid is:

A

Plasma-Lyte

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12
Q

What element does LR add that NS does not have?

A

Potassium

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13
Q

When is LR and NS typically used?

A

Resuscitation
Hypovolemia

Not normally used for maintenance fluids

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14
Q

When is D5W used?

A

Usually as a maintenance fluid

Add 20mEq of K to prevent hypokalemia

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15
Q

1 unit of packed RBC’s raises the Hgb by how much?

A

1

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16
Q

How long does FFP take to thaw?

A

About a half-hour

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17
Q

For which patient are platelets usually reserved?

A

Actively bleeding <50K platelet count

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18
Q

1 unit of platelets raises the platelet count apprx:

A

25K

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19
Q

Which type of patients will receive IV albumin:

A

Liver failure
Burns
Nephrotic syndrome

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20
Q

Ratio for PRBC:FFP:PLT

A

1:1:1

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21
Q

Which kind of patients might get hypertonic saline?

A

Hemorrhage (increases intravascular volume)

Head injury (increases cerebral perfusion pressure and decrease intracranial pressure)

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22
Q

Hypertonic saline works by:

A

Drawing fluid into the intravascular space

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23
Q

What is hetastarch and when is it used?

A

Large sugar molecule used to increase intravascular volume

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24
Q

What adverse outcome is the use of hetastarch associated with?

A

Increased mortality and acute kidney injury

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25
Q

What is tranexamic acid?

A

Anti-fibrinolytic agent (strengthens clot - used in trauma)

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26
Q

What is DDAVP?

A

Stimulates endothelial cells to release von Willebrand Factor? (VWF)

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27
Q

What’s in cryoprecipitate?

A

Factor VIII

VWF

Fibrinogen

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28
Q

What is aminocaproic acid?

A

Anti-fibrinolytic agent (strengthens clot)

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29
Q

Thromboelastrography

A

Slide 13 - chart - some cards on it later

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30
Q

What is TKO or KVO

A

To keep open or keep vein open

Just enough fluid running in to keep the catheter patent

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31
Q

A heparin lock or saline lock, useful for:

A

Antibiotics or PRN pain meds

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32
Q

Intraosseous infusion - placed (drilled) into which bones typically?

A

Femur
Humerus
Tibia

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33
Q

What is the FAST-1?

A

Special IO placed in the sternum

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34
Q

Indications for IO’s?

A

Failed IV-access attempts

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35
Q

CI’s for IO’s

A

Fx in bone in which IO is placed (can lead to compartment syndrome)

36
Q

Common sites for central lines?

A

Subclavian
Internal jugular
Femoral

37
Q

Central lines ideal for:

A

Larger volumes of fluid
More caustic medications
TPN

Can add transducers to directly monitor hemodynamics

38
Q

Central lines can increase risk of:

A

Pneumothorax (PTX)
Hematoma
Infection
Cardiac injury

39
Q

How often are central lines changed out?

A

Q 5-7 days or as soon as no longer necessary

40
Q

What is the Seldinger Technique?

A

Method of central line placement

41
Q

Where is the arterial line typically placed in adults?

A

Radial artery

42
Q

What are ports used for?

A

Long-term medications (chemotherapy or antibiotics)

Placed under floro or CT guidance

43
Q

What is a peripherally inserted central catheter (PICC)?

A

Very long catheter

Inserted into a peripheral vein, threaded to superior vena cava

44
Q

Potential complications of PICC?

A

Infection
Break
Air embolus

45
Q

If patient is dehydrated and will be NPO for >12 hrs, the IV fluid maintenance rate for adults is:

A

35ml/kg/24hrs

46
Q

Maintenance IV fluids for kids:

A

0-10kg: 100ml/kg/24hrs

Plus 10-20kg add: 50ml/kg/24hrs

Plus >20kg add: 20ml/kg/24hrs

47
Q

Caveman method of IV fluid maintenance:

A

Bolus 1/2- 1 liter and adjust UOP to 0.5 - 1ml/kg/hr

48
Q

Signs of volume depletion:

A

Decreased skin turgor

Tachycardia

HOTN

Oliguria

49
Q

Normal UOP for adults

A

0.5-1ml/kg/h

50
Q

Normal UOP for kids

A

1ml/kg/h

51
Q

Normal UOP for babies

A

2ml/kg/h

52
Q

In the post patient with decreased UOP, tx with:

A

IV fluid bolus

53
Q

Indication for indwelling urinary catheter (Foley)

A

Accurate I/O needed

Preoperatively

Prolonged immobilization with sedation

Neurogenic bladder

54
Q

Complications of Foley cath?

A

UTI

Urethral injury

55
Q

Describe the pulmonary artery catheter

A

Measures PA pressure directly

Used to assess patient’s fluid status

Balloon inflated with sterile water

Floated through right heart chambers and wedges in pulmonary artery

56
Q

Normal spec-grav or urine is appx

A

1.010

57
Q

Urine spec-grav higher than _____ suggests dehydration

A

1.020

58
Q

Clinical signs suggesting fluid overload

A 
JVD
Peripheral edema 
S3 gallop on cardiac exam
Ascites, anasarca
Rales on pulmonary exam
DOE
59
Q

What are Flotrac and Vigileo?

A

Used along with serum lactate to assess hydration status

Measures 2000 data points every 20 seconds

ScvO2 >70% with normal lactate = good

60
Q

Short-term total enteral nutrition (TEN)

A

Placed small bore, weighted, post-pyloric feeding tube

61
Q

Long-term TEN:

A

PEG or J-tube

62
Q

Total parenteral nutrition (TPN) is given via:

A

Central catheter

63
Q

Things to monitor with TPN

A

Daily electrolytes (inpatient)

Weekly liver enzymes

64
Q

Gastric tubes are placed to:

A

Decompress the stomach

65
Q

Gastric tubes are commonly placed in patients with:

A

N/V
Pre-op (ate within 6 hrs)
Ileus or large obstruction

66
Q

CI’s to gastric tube:

A

Cribiform plate / basilar skull fx

67
Q

Complications of gastric tube

A

Esophageal / stomach injury

Hypokalemia -> metabolic acidosis

68
Q

Feeding tube is used for:

A

Short-term feeding

Small-bore, weighted, post-pyloric

69
Q

How is feeding tube placement confirmed?

A

It has a nifty radiopaque tip, visible on KUB films

70
Q

Plasma and interstitial fluid electrolyte breakdown:

A

Cations - mostly sodium, a little potassium and some other stuff

Anions - mostly chloride, a little bicarb, others (for plasma, also PROTEIN anions)

Only difference really between plasma and interstitial fluid is that plasma has the PROTEIN ANIONS

71
Q

Electrolyte concentrations for intracellular fluid (skeletal muscle):

A

Cation - mostly potassium, a little sodium, and others

Anion - mostly phosphate, some protein anions, and others

72
Q

Peripheral parenteral nutrition vs total parenteral nutrition - access:

A

PPN can be through a normal IV

TPN has to be via a central line

73
Q

Fluid with highest choride?

A

Normal saline

Can exacerbate acidosis

74
Q

Most isotonic fluid?

A

P-lyte

75
Q

If patient is going to get blood products or IV ABX, which fluid?

A

Normal saline

76
Q

If pt is acidotic, which fluid do we select?

A

LR

77
Q

Crystalloid examples:

A

NS and LR

Used for resuscitation

78
Q

Examples of colloids:

A 
Whole blood
RBC’s
FFP
PLT
Albumin
79
Q

Which blood product has the most bang for its buck?

A

FFP

80
Q

TEG - problems with R time - give:

A

FFP

81
Q

TEG - problems with K time - give:

A

Cryoprecipitate

82
Q

TEG - problems with Alpha angle - give:

A

Cryoprecipitate

83
Q

TEG - problems with maximum amplitude - give:

A

DDAVP and/or platelets

84
Q

TEG - problems with LY30 - give:

A

TXA and/or Aminocaproic acid

85
Q

Increased hematocrit with no change in RBC’s suggests:

A

Dehydration

86
Q

Question: Does an apple a day keep the doctor away?

A

Answer: Only if you aim it well enough.

Senior - Surgery 1 (8 decks)

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