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Fa: Methods 2 > 11. Advanced Fluid Management - Editing > Flashcards

11. Advanced Fluid Management - Editing Flashcards

1
Q

hydrostatic pressure

A

pressure exerted against the capillary walls

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2
Q

intravascular hydrostatic pressure drives blood what way

A

out of blood vessel

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3
Q

interstitial hydrostatic pressure drives blood what way

A

into blood vessels

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4
Q

oncotic pressure

A

form of osmotic pressure exerted by proteins

pulls fluid towards itself

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5
Q

intravascular oncotic pressure drives fluid what way

A

into blood vessels

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6
Q

interstitial oncotic pressure drives fluid what way

A

out of blood vessels

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7
Q

oncotic pressure opposes?

A

oncotic pressure opposes hydrostatic pressyre

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8
Q

decreased intravascular oncotic pressure can lead to what

A

edema

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9
Q

why is there edema in pregnancy

A

incr plasma volume
decr plasma [albumin]
decr cap oncotic pressure
incr interstitial fluid (edema)

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10
Q

why is there edema in liver failure

A

decr plasma [albumin]
decr cap oncotic pressure
incr edema

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11
Q

capillary arterial end net filt pressure and direction

A

net filtration pressure of 13
OUT of blood vessels

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12
Q

venous end net filt pressure and direction

A

net filtration pressure 7
INTO blood vessels

INTO blood vessels

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13
Q

What happens to the 6 left in the interstitial fluid?

A

taken by lymphatic system back to lymph nodes
drains into subclavian vein

drain into subclavian vein

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14
Q

lymphatic system function

A

maintain fluid balance
protects body from infection

protect body from infection

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15
Q

moles

A

refer to compounds

NaCl

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16
Q

osmoles

A

refer to ions

Na+ Cl-

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17
Q

osmolality

A

number osmoles/kg solvent

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18
Q

osmolarity

A

number osmoles/L

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19
Q

plasma osmolarity

A

280-290 mOsm/L

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20
Q

what 3 things regulate osmolarity

A

hypothalamus
carotid baroreceptors
kidneys

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21
Q

what does the hypothalamus do to regulate osmolarity

A

osmolarity high=
tells posterior pituitary to:
secrete ADH
sense of thirst

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22
Q

what do the carotid and baroreceptor and kidneys do to regulate osmolarity

A

sense a decrease in blood volume

send message to brain to secrete ADH

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23
Q

molarity

A

how concentrated one solution is compared to another

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24
Q

hyperosmolar

A

higher conc of total solutes than other side of membrane

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25
Q

hypoosmolar

A

lower concentration of total solutes thatn other side of membrane

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26
Q

tonicity

A

which direction water moves

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27
Q

hypertonic

A

water moves toward the solution

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28
Q

hypotonic

A

water moves away from the solution

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29
Q

hypertonic IV solution definition

A

osmolarity of >375 mOsm/L

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30
Q

effects of hypertonic IV solution on the body

A

cells of the body shrink
blood volume incr/expands

blood volume increases

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31
Q

3 hypertonic IV solutions

A

mannitol
hypertonic 3% N/S
D5 Solution (except D5W)

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32
Q

mEq/L of 3% N/S

A

513 mEq/L

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33
Q

D5 solution

A

5% dextrose in bag or vial

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34
Q

D50 solution

A

50% dextrose in bag or vial

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35
Q

5% dextrose is what mg/mL?

A

50mg/mL

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36
Q

50% dextrose is what mg/mL

A

500mg/mL

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37
Q

pediatric dose of dextrose

A

0.25-0.5g/kg

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38
Q

adult dose of dextrose

A

0.5-1g/kg

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39
Q

3 indications for hypertonic fluids

A

3% N/S to correct plasma sodium conc.
glucose solution for maintenance for NPO or normalize sugar
mannitol for increase renal perfusion and neurosurgery to shrink brain cells

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40
Q

complications of hypertonic IV fluids

A
  • if 3% N/S given too rapidly then the brain can have central pontine myelinolysis and death
  • osmotic diuresis
  • loss of electrolytes
  • intracellular dehydration
  • coma
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41
Q

hypotonic IV solution definition

A

osmolarity of <250mOsm/L

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42
Q

effects of hypotonic IV fluids on the body

A

cells of the body will expand
blood volume decr

blood volume decreases

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43
Q

3 hypotonic solutions

A

0.45% N/S
2.5% Dextrose in Water
D5W

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44
Q

is D5W really hypotonic?

A

starts isotonic but glucose is rapidly metabolized in the body and becomes hypotonic

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45
Q

indications for hypotonic IV fluids

A

hypernatremia (water deficit)

water deficit

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46
Q

2 complications of hypotonic fluids

A 
cause phlebitis (go through central line)
cerebral edema (contraindicated in pts with increased ICP)
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47
Q

isotonic solution definition

A

osmolarity of 250-375 mOsm/L

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48
Q

4 types of isotonic solution

A

LR
N/S 0.9%
normosol (plasmalyte)
5% albumin

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49
Q

osmolarity of LR

A

273 mOsm/L

slightly hypotonic

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50
Q

contents of LR

A

Na
K
Ca
Cl
lactate

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51
Q

what is lactate converted to by the liver?

A

bicarb and glucose

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52
Q

4 contraindications to LR

A 
liver disease/liver failure
neurosurgery
incr ICP
ceftriaxone (Rocephin)
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53
Q

questionable CI to LR

A

pts w/metabolic acidosis/pyloric stenosis
blood
diabetes
renal failure

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54
Q

why not hang LR with blood

A

Ca is clotting factor IV

calcium could chelate the citrate anticoagulant preservative and form clots

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55
Q

why not hang LR in liver failure

A

lactate builds up and cant be converted thus causing lactic acidosis (elevated anion gap metabolic acidosis)

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56
Q

why avoid LR in diabetes?

A

lactate is converted to glucose and exacerbates hyperglycemia

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57
Q

why avoid LR in renal failure?

A

LR contains potassium and renal failure pts are at risk for hyperkalemia

58
Q

why avoid LR in neurosurgery?

A

slightly hypotonic fluid could incr ICP

59
Q

why is ceftriaxone (rocephin) CI with LR for neonates?

A

risk of fatal ceftriaxone-calcium salt precipitation in the bloodstream

60
Q

why is ceftriaxone (Rocephin) CI in pts > 28 days with LR?

A

cannot be given simultaneously because it may precipitate in IV line

61
Q

why is LR CI in pts with pyloric stenosis?

A

pts with pyloric stenosis have met alkalosis
Lactate converts to bicarb = worsens alkalosis

62
Q

osmolarity of 0.9% N/S

A

308 mOsm/L
slightly hypertonic to plasma/LR

slightly hypertonic

63
Q

each L of 0.9% N/S contains how much mEq of sodium?

A

154mEq

64
Q

what can large volumes of N/S 0.9% administration lead to?

A

non anion gap metabolic acidosis

65
Q

osmolarity of normosol

A

294 mOsm/L

66
Q

contents of normosol

A

Na, K, Mg, Cl

  • doesnt have lactate or calcium
67
Q

potassium conc in normosol

A

5mEq/L

68
Q

potassium conc in LR

A

4mEq/L

69
Q

indications for plasmalyte

A

blood transfusions
liver failure

liver failure

70
Q

why is plasmalyte better for liver failure than LR

A

does not contain lactate

71
Q

why is plasmalyte better for pts in metabolic acidosis?

A

plasmalyte is more alkalinizing than LR

72
Q

conc bicarb normosol

A

50mEq/L

73
Q

conc bicarb LR

A

28mEq/L

74
Q

contraindications for normosol

A

none

75
Q

most common colloid used in hypovolemic pts

A

5% albumin

76
Q

5% albumin will expand the intravascular volume how much?

A

mL for mL

77
Q

20-25% mannitol indication

A

large blood volume deficit
oncotic deficit

hypoproteinemia

78
Q

Hespan

A

colloid used as alternative to albumin
6% hetastarch

79
Q

what is the risk with hespan

A

black box warning increased mortality

80
Q

when would you use hespan?

A

allergy to albumin

jehovah witness

81
Q

Blood volume preterm infant

A

90-100mL/kg

82
Q

blood volume pregnant pt at term

A

90-100 mL/kg

83
Q

blood volume full term neonate

A

90mL/kg

84
Q

blood volume infant

A

80mL/kg

85
Q

blood volume male

A

70-75mL/kg

86
Q

blood volume female

A

60-65mL/kg

87
Q

blood volume elderly & obese

A

~15% less than adults

88
Q

TBW males: healthy, obese, geriatric

A

healthy- 60%
obese- 50%
geriatric- 50%

89
Q

TBW females: healthy, obese, geriatric

A

healthy- 50%
obese- 40-45%
geriatric- 40-45%

90
Q

TBW neonate

A

80%

91
Q

TBW infant

A

70%

92
Q

intracellular fluid % of TBW

A

65%

93
Q

extracellular fluid % of TBW

A

35%

94
Q

extracellular: interstitial fluid

A

70-75%

TBW 25%

95
Q

extracellular fluid: intravascular fluid

A

25-30%

96
Q

TBW overall breakdown

A

intracellular: 65%
interstitial: 25%
intravascular: 10%

97
Q

interstitial + intravascular =

A

extracellular = 35% of TBW

98
Q

what % of total fluid in the human body is blood?

A

10%

99
Q

as children grow into adults, TBW _______

A

decreases

100
Q

as children grow into adults, % of intracelluar fluid ________
% of extracellular fluid ____________

A

% of intracellular incr
% of extracellular decr

101
Q

lasix

A

loop diuretic

inhibits water and sodium reabsorption in LOH

102
Q

indications for lasix 3

A

fluid overload
- edema
- pulm edema
- nephrotic syndrome
- CHF
chronic HTN
offsetting increased ADH in surgery

103
Q

is lasix renal protective or increase renal blood flow?

A

no

104
Q

mannitol

A

osmotic diuretic

increases osmolarity of blood, expands plasma volume

105
Q

mannitol causes

A

incr blood osmolarity
incr plasma volume
cells shrink

106
Q

mannitol indications

A

renal protection and perfusion
brain surgery (causes decr ICP)

brain surgery

107
Q

does mannitol increase renal perfusion?

A

yes

108
Q

spirolactone

A

usually at home mediations

potassium sparing

109
Q

spironolacton is a _______ diuretic

A

potassium sparing diuretic

110
Q

spironolactone SE

A

hyperkalemia

111
Q

acetazolamide

A

carbonic anhydrase inhibitor

decrease bicarb and increase PaCO2

112
Q

complication of acetazolamide

A

metabolic acidosis
hypokalemia

113
Q

indications for acetazolamide

A

diuretic to treat heart failure edema
treat glaucoma and lower intraocular pressure
epilepsy
treat altitude sickness

114
Q

nephrotic syndrome

A

kidney disorder that causes the body to excrete too much protein in urine, damage to nephrons

115
Q

3 symptoms of nephrotic syndrome

A

proteinuria
hypoalbuminemia
fluid overload (edema)

116
Q

treatment for nephrotic syndrome

A

finding and fixing underlying cause

117
Q

adult major burn definition

A

> 20% of TBSA

118
Q

kids and elderly major burn definition

A

> 10% TBSA

119
Q

automatic major burn

A

face
airway
genitalia

120
Q

what things make it a major burn regardless of TBSA?

A

burn to face
airway
genitalia

121
Q

describe rule 9

A 
head 9
front 18
back 18
arm 9 each
leg 18 each
genitalia 1
122
Q

rule of 9 for peds

A

head 18
front 18
back 18
arm 9 each
leg 14 each
genitalia 1

123
Q

patients with major thermal injury are expected to experience:

A

inflammatory response
massive vasodilation
fluid shift from IV INTO interstitial
injury to muscles
loss of skin protective barriers

124
Q

physiology after thermal injury

A
  1. hypovolemia
  2. decr CO
  3. hTN
  4. massive edema
  5. hypothermia
  6. anemia/thrombocytopenia
  7. hypercoagulability
  8. altered pulm phys
  9. incr nicotinic Ach R
  10. hypermetabolic
125
Q

why is there hypovolemia and decreased CO in burn pts

A

drainage and evaporation from wounds
relative hypovolemia from vasodilation

intense infammatory response leads to vasodilation

126
Q

how is anemia and throbocytopenia caused in burn pts

A

bleeding from wounds
heat damage to RBC
fluid resuscitation

127
Q

proliferation of nicotinic ach receptors causes what?

A

resistance to NDMB
sensitivity to Sux

sensitivity to succ

128
Q

how long dose it take for proliferation of nicotinic Ach to occur?

A

24 hrs post burn

129
Q

possible complications of altered pulm physiology include

A

decr pulm compliance
incr lung vascular and permeability incr PVR
possible carbon monoxide poisoning

130
Q

what is the hypermetabolic phase caused by

A

massive surge of catecholamines and corticosteriods

131
Q

what does the hypermetabolic phase lead to?

A

tachycardia
hypertension
incr myocardial o2 consumption
multisystem organ failure

132
Q

when does the hypermetabolic phase develop?

A

can take several weeks

133
Q

what is the first priority for anesthesia management in thermal injury?

A

secure the airway

134
Q

safest option to intiubate burn pts?

A

awake fiberoptic intubation

135
Q

when should you promptly intubate a burn pt

A

burns to face
neck
upper chest
inhalational burns

136
Q

drug dosing initial burn shock phase (48hr)

A

vasodilation and low cardiac output = lower drug doses

137
Q

hypermetabolic phase (48-72hr, lasting weeks or months) drug dosing

A

fluid overload can occur after capillary membrane integrity returns and fluid shifts
higher drug dose
MAC increased

138
Q

succ in burn pts

A

safe in first 24 hr
avoided in 24-48 hr
consider using again after 1-2 yrs

139
Q

does the magnitude of hyperkalemic response correlate to the magnitude of burn?

A

no

140
Q

3 intraoperative goals burn pt

A

rapid and effective intravascular volume replacement (parkland formula)
low tidal volume (6mL/kg and PIP <30
minimize heat loss

141
Q

parkland formula

A

(4mL)(%BSA)(kg)= volume of LR
half given first 8 hr
half given next 16 hr

142
Q

colloids and burn pts

A

conflicting ideas

could leak from intravascular space and worsen edema

Fa: Methods 2 (16 decks)

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