#4 Fluids

Question 1

Why do we do volume resuscitation? (3)

Answer 1

• Restore volume lost, to sustain critical organ perfusion
• To maintain oxygen carrying capacity for adequate cellular oxygen delivery
• To correct derangements in coagulation

Question 2

Lethal Triad associated with mortality in trauma:

Answer 2

hypothermia
acidosis
coagulopathy

Question 3

3 initial keys to survival in ER:

Answer 3

crystalloid
emergency release blood, O negative blood
pts blood type

Question 4

mechanical force forcing water out of capillaries and into interstitium

Answer 4

capillary filtration pressure

Question 5

opposes movement of water out of the capillary

Answer 5

interstitial fluid pressure

Question 6

pulls water back into cap

Answer 6

capillary colloid osmotic pressure

—osmotic pressure generated by plasma proteins, too large to pass through the porous capillaries

Question 7

pulls water from cap into the interstitial space

Answer 7

tissure colloid osmotic pressure

Question 8

Causes of absolute hypovolemia: (5)

Answer 8

hemorrhage
burns
vomiting
polyuria
evaporation (surgery and sweating)

Question 9

Causes of relative hypovolemia: (5)

Answer 9

capillary leak (inflammation, burns, trauma, and anaphylaxis)
effusions (pleural and ascites)
vasodilation (inflammation, anaphylaxis, spinal surgery, and anesthesia)

Question 10

Acute hemorrhage SXS: (4)

Answer 10

1- Tachycardia
2- Hypotension
3- Poor peripheral perfusion:   
-- weak pulses   
-- prolonged cap refill
4- AMS or ACS 2/2 poor global perfusion

Question 11

Colloid Types (5)
HAD GF

Answer 11

HAD GF
Hetastarch
Albumin
Dextrose
Gelatin
FFP
--RBCs NOT colloids

Question 12

LR risks in hemorrhagic replacement for hypovolemia: (4)

Answer 12

-Buffers acidemia>NS
1-increased cytokine release
2-acidemia
3-Hyperkalemia is a risk (caution in renal patients)
4-BOTH increase neutrophil activation

Question 13

NS risks in hemorrhagic replacement for hypovolemia: (3)

Answer 13

1- Slightly hyperosmolar
2- Risk of inducing hyperchloremic metabolic acidosis w. large volumes via IC K+ depletion
3- BOTH increase neutrophil activation

Question 14

FFP universal donor

Answer 14

AB for FFP

Question 15

Contents of FFP (3) and metabolites found (6)

Answer 15

• -PRO salt soln w. RBC’s, WBC’s, PLTs are suspended
• -92% water (constitutes 55% blood vol.)
• -clotting factors
• -it is a colloid
• albumin
• fibrinogen
• globulin
• glucose
• lytes
• hormones and CO2

Question 16

FFP uses: (2)

Answer 16

• Correction of bleeding that is likely 2/2 factor deficiencies
• urgent reversal of Coumadin (Vit K takes too long)

Question 17

Normal circulating volume of an adult:

Answer 17

7% of IDEAL body weight; 70 kg individual: 5Liters (3 L plasma, 2 L RBC)

Question 18

Transfusion recommended with Hgb and hematocrit levels of:

Answer 18

hgb: <6 mg/dL
hct: <18 mg/dL

Question 19

Class 1 hemorrhage:

• % blood loss
• clinical response
• comments

Answer 19

<15% (750 mL)

• minimal to no change in VS
• fluid may not even be necessary if bleeding stops

Question 20

Class 2 hemorrhage:

• % blood loss
• clinical response
• comments

Answer 20

15-30% (750-1500 mL)

• AMS
• peripheral vasoconstriction
• tachcardia/narrow pulse pressures
• mild HoTN
• –restore fluids, if RBC normal, prior- volume restored blood transfusion not necessary

Question 21

Class 3 hemorrhage:

• % blood loss
• clinical response
• comments

Answer 21

30-40% (1500-2000 mL)
worsening:
-tachycardia
-HoTN
-hypoperfusion
-AMS
---restore volume and RBC

Question 22

Class 4 hemorrhage:

• % blood loss
• clinical response
• comments

Answer 22

>40% (>2000mL)
worsening:
-tachycardia
-HoTN
-hypoperfusion
-AMS
---w/o aggressive mgmt, limited ability to compensate