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ANSTZ > A.8 > Flashcards

A.8 Flashcards

1
Q

how to evaluate fluid status?

A
  • clinical
  • echo
  • CVP monitoring
  • PiCCO
  • swan ganz
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2
Q

fluid status evaluation clinical aspect?

A
  • skin turgor
  • tongue and mucous mem. dryness
  • daily urine output
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3
Q

what do we check in fluid status evaluation during echocardiography?

A
  • IVC diameter
  • IVC collapsebility: spon. breathing (indicates fluid responsiviness)
  • IVC distensibility: when patient is on ventilator
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4
Q

how do we monitor CVP?

A
  • invasive
  • catheter through SVC
  • measures pressure rather than volume
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5
Q

PiCCO meaning?

A
  • Pulse index Continous CO
  • invasive method uses 2 techniques for advanced hemodynamic and volumetric monitoring
  • transpulmonary thermodilution: to monitor PRELOAD
  • pulse contour analysis: to measure CO and SV
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6
Q

What is swan-ganz catheter?

A
  • pulmonary artery catheter
  • very invasive
  • most accurate
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7
Q

what can we monitor with swan-ganz?

A
  • Cardiac pressure
  • pulmonary pressure
  • mixed venous saturation
  • central temp
  • continuous CO monitoring
  • PWCP (preload)
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8
Q

Isotonic crystalloids?

A

0.9% saline solution
Lactate ringer
Isolyte

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9
Q

when do we use isotonic crystalloids?

A

best for IV resuscitation

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10
Q

normal saline (0.9% NaCl) application?

A
  • fluid resuscitation
  • maintenance fluid therapy
  • hypovolemic hyponatremia
  • solvent for IV drugs
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11
Q

risks of using 0.9 Nacl?

A
  • hyperchloremic acidosis
  • fluid overload
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12
Q

what is Lactate Ringer’s solution?

A

Na
Cl
K
Ca
lactate

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13
Q

Lactate ringer’s clinical application?

A

fluid resuscitation
maintenance fluid therapy

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14
Q

Risks of lactate ringer’s?

A
  • lactate accumulation in liver failure
  • contains calcium
  • fluid overload
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15
Q

hypotonic crystalloid

A

Saline solution (0.45% and 0,22%)
Dextrose Solution (5% and 10%)

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16
Q

clinical applications of dextrose solutions?

A
  • correction of free water deficit (Hypernatremia)
  • maintenance of fluid therapy
  • dextrose is good solvent for IV drugs (NE infusion)

increases EC vol. and IC vol.

17
Q

risks of dextrose solutions?

A
  • hyponatremia
  • pulmonary edema
  • cerebral edema
  • hyperglycemia
  • hyperkalemia
18
Q

hypotonic saline solutions clinical applications?

A
  • correction of free water deficit (Hypernatremia)
  • maintenance of fluid therapy

increases both EC and IC volumes

19
Q

risks of hypotonic saline solutions?

A
  • hyponatremia
  • pulmonary edema
  • cerebral edema
20
Q

characteristics of Colloid fluids?

A
  • contains large proteins
  • cause 1:1 ration of volume increase
  • increase IV oncotic pressure
  • risk of fluid overload
  • controversial should be reserved for special situations
21
Q

hypertonic crystalloids?

A

3% NaCl
5% NaCl

must be administered with extremeee caution(risk of ODS)

22
Q

clinical applications of hypertonic crystalloids?

A
  • severe hyponatremia
  • cerebral edema

increases EC volume
decreases IC volume

23
Q

risks of hypertonic crystalloids?

A

ODS

24
Q

2 things about 0.45% NaCl fluid

A

Hypotonic
Used in hypernatremia (correct free water deficit)

25
Q

Fluids in hypovolemic patient?

A

Isotonic fluid
Normal Saline (0.9%)
Switch to plasmalyte or LR if high volume

26
Q

Fluids in hyponatremia

A

Hypertonic saline solution (3%)
Normal Saline

27
Q

about colloidal solutions

A

controversial. should be preserved for special cases

high mW substances that remain confined to the intraVascular space –>generate oncotic pressure

they have greater effect on intraVascular volume than crystalloid

28
Q

types of colloidal solutions?

A

natural:
- albumin
- FFP (fresh frozen plasma)

artificial:
- gelatin
- dextran
- hydroxyethyl starch (HES)

29
Q

indication of colloidal solution?

A

acute hemorrhage

ANSTZ (7 decks)

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