Advanced Fluid Management Flashcards
1
Q
hydrostatic pressure
A
pressure exerted against the capillary walls
2
Q
intravascular hydrostatic pressure drives blood what way
A
out of blood vessel
3
Q
interstitial hydrostatic pressure drives blood what way
A
into blood vessels
4
Q
oncotic pressure
A
form of osmotic pressure exerted by proteins
pulls fluid towards itself
5
Q
intravascular oncotic pressure drives fluid what way
A
into blood vessels
6
Q
interstitial oncotic pressure drives fluid what way
A
out of blood vessels
7
Q
decreased intravascular oncotic pressure can lead to what
A
edema
8
Q
why is there edema in pregnancy
A
plasma volume increases
albumin conc decreases
intravascular oncotic pressure decreases
9
Q
why is there edema in liver failure
A
plasma albumin conc decreases bc of decreased albumin synthesis
decreased intravascular oncotic pressure
10
Q
capillary arterial end net filt pressure and direction
A
net filtration pressure of 13 OUT of blood vessels
11
Q
venous end net filt pressure and direction
A
net filtration pressure 7
INTO blood vessels
12
Q
What happens to the 6 left in the interstitial fluid?
A
taken by lymphatic system back to lymph nodes
drain into subclavian vein
13
Q
lymphatic system function
A
maintain fluid balance
protect body from infection
14
Q
moles
A
refer to compounds
NaCl
15
Q
osmoles
A
refer to ions
Na+ Cl-
16
Q
osmolality
A
number osmoles/kg solvent
17
Q
osmolarity
A
number osmoles/L
18
Q
plasma osmolarity
A
280-290 mOsm/L
19
Q
what 3 things regulate osmolarity
A
hypothalamus
carotid baroreceptors
kidneys
20
Q
what does the hypothalamus do to regulate osmolarity
A
osmolarity high=
tells posterior pituitary to:
secrete ADH
sense of thirst
21
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
22
Q
molarity
A
how concentrated one solution is compared to another
23
Q
hyperosmolar
A
higher conc of total solutes than other side of membrane
24
Q
tonicity
A
which direction water moves
25
hypertonic
water moves toward the solution
26
hypertonic IV solution definition
osmolarity of >375 mOsm/L
27
effects of hypertonic IV solution on the body
cells of the body shrink
| blood volume increases
28
3 hypertonic IV solutions
mannitol
hypertonic 3% N/S
D5 Solution (except D5W)
29
mEq/L of 3% N/S
513 mEq/L
30
D5 solution
5% dextrose in bag or vial
31
D50 solution
50% dextrose in bag or vial
32
5% dextrose is what mg/mL?
50mg/mL
33
50% dextrose is what mg/mL
500mg/mL
34
pediatric dose of dextrose
0.25-0.5g/kg
35
adult dose of dextrose
0.5-1g/kg
36
3 indications for hypertonic fluids
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
37
complications of hypertonic IV fluids
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
38
hypotonic IV solution definition
osmolarity of <250mOsm/L
39
effects of hypotonic IV fluids on the body
cells of the body will expand
| blood volume decreases
40
3 hypotonic solutions
0.45% N/S
2.5% Dextrose in Water
D5W
41
is D5W really hypotonic?
starts isotonic but glucose is rapidly metabolized in the body and becomes hypotonic
42
indications for hypotonic IV fluids
hypernatremia
| water deficit
43
2 complications of hypotonic fluids
```
cause phlebitis (go through central line)
cerebral edema (contraindicated in pts with increased ICP)
```
44
isotonic solution definition
osmolarity of 250-375 mOsm/L
45
4 types of isotonic solution
LR
N/S .9%
normosol
5% albumin
46
osmolarity of LR
273 mOsm/L
| slightly hypotonic
47
contents of LR
Na, K, Ca, Cl, lactate
48
what is lactate converted to by the liver?
bicarb and glucose
49
5 contraindications to LR
```
hanging with blood?
liver disease/failure
brain surgery
diabetes?
renal failure?
```
50
why not hang LR with blood
calcium could chelate the citrate anticoagulant preservative and form clots
51
why not hang LR in liver failure
lactate builds up and cant be converted thus causing lactic acidosis (elevated anion gap metabolic acidosis)
52
why avoid LR in diabetes?
lactate is converted to glucose and exacerbates hyperglycemia
53
why avoid LR in renal failure?
LR contains potassium and renal failure pts are at risk for hyperkalemia
54
osmolarity of .9% N/S
308 mOsm/L
| slightly hypertonic
55
each L of .9% N/S contains how much mEq of sodium?
154mEq
56
what can large volumes of N/S .9% administration lead to?
non anion gap metabolic acidosis
57
osmolarity of normosol
294 mOsm/L
58
contents of normosol
Na, K, Mg, Cl
* doesnt have lactate or calcium
59
potassium conc in normosol
5mEq/L
60
potassium conc in LR
4mEq/L
61
indications for plasmalyte
blood transfusions
| liver failure
62
conc bicarb normosol
50mEq/L
63
conc bicarb LR
28mEq/L
64
contraindications for normosol
none
65
most common colloid used in hypovolemic pts
5% albumin
66
5% albumin will expand the intravascular volume how much?
mL for mL
67
Hespan
colloid used as alternative to albumin
68
what is the risk with hespan
black box warning increased mortality
69
when would you use hespan?
allergy to albumin
| jehovah witness
70
Blood volume preterm infant
90-100mL/kg
71
blood volume full term neonate
90mL/kg
72
blood volume infant
80mL/kg
73
blood volume male
70-75mL/kg
74
blood volume female
60-65mL/kg
75
blood volume elderly & obese
~15% less than adults
76
TBW males: healthy, obese, geriatric
healthy- 60%
obese- 50%
geriatric- 50%
77
TBW females: healthy, obese, geriatric
healthy- 50%
obese- 40-45%
geriatric- 40-45%
78
TBW neonate
80%
79
TBW infant
70%
80
intracellular fluid % of TBW
65%
81
extracellular fluid % of TBW
35%
82
interstitial fluid % of extracellular fluid and TBW
extra- 75%
| TBW 25%
83
intravascular fluid % of extracellular fluid and TBW
extra- 25%
| TBW 10%
84
lasix
loop diuretic
| inhibits water and sodium reabsorption in LOH
85
indications for lasix 3
fluid overload
chronic HTN
offsetting increased ADH in surgery
86
is lasix renal protective or increase renal blood flow?
no
87
mannitol
osmotic diuretic
| increases osmolarity of blood, expands plasma volume
88
mannitol indications
renal protection and perfusion
| brain surgery
89
does mannitol increase renal perfusion?
yes
90
spirolactone
usually at home mediations
| potassium sparing
91
acetazolamide
carbonic anhydrase inhibitor
| decrease bicarb and increase PaCO2
92
complication of acetazolamide
metabolic acidosis
93
indications for acetazolamide
diuretic to treat heart failure edema
treat glaucoma and lower intraocular pressure
treat altitude sickness
94
nephrotic syndrome
kidney disorder that causes the body to excrete too much protein in urine, damage to nephrons
95
2 symptoms of nephrotic syndrome
proteinuria
hypoalbuminemia
fluid overload (edema)
96
treatment for nephrotic syndrome
finding and fixing underlying cause
97
adult major burn definition
>20% of TBSA
98
kids and elderly major burn definition
>10% TBSA
99
what things make it a major burn regardless of TBSA?
burn to face
airway
genitalia
100
describe rule 9
```
head 9
front 18
back 18
arm 9 each
leg 18 each
genitalia 1
```
kids: 9 more in head, 8 less on legs, 1 less genitalia
101
physiology of pts after thermal injury 9
```
1 hypovolemia and decreased CO
2 massive leak of fluids and electrolytes into interstitial space
3 hypothermia
4 anemia and throbocytopenia
5 hypercoaguable state
6 proliferation nicotinic ach receptors after 24hr
7 acute renal failure
8 altered pulm physiology
9 hypermetabolic phase
```
102
why is there hypovolemia and decreased CO in burn pts
drainage and evaporation from wounds
| intense infammatory response leads to vasodilation
103
what does the increased capillary permeability and massive leak of fluids lead to?
hypovolemia, hypotension, burn shock
| massive edema in all tissue
104
how is anemia and throbocytopenia caused in burn pts
bleeding from wounds
heat damage to RBC
fluid resuscitation
105
proliferation of nicotinic ach receptors causes what?
resistance to nondep
| sensitivity to succ
106
possible complications of altered pulm physiology include
decreased pulm compliance
increased lung vascular and permeability and PVR
possible carbon monoxide poisoning
107
what is the hypermetabolic phase caused by
massive surge of catecholamines and corticosteriods
108
what does the hypermetabolic phase lead to?
increased myocardial oxygen demand
insulin resistance
fever
liver dysfunction
109
when does the hypermetabolic phase develop?
can take several weeks
110
what is the first priority for anesthesia management in thermal injury?
airway assessment
potential intubation
awake fiberoptic best
111
when should you promptly intubate a burn pt
burns to face
neck
upper chest
inhalational burns
112
drug dosing initial burn shock phase (48hr)
vasodilation and low cardiac output = lower drug doses
113
hypermetabolic phase (48-72hr, lasting weeks or months) drug dosing
fluid overload can occur after capillary membrane integrity returns and fluid shifts in
higher drug dose
MAC increased
114
succ in burn pts
safe in first 24 hr
avoided in 24-48 hr
consider using again after 1-2 yrs
115
does the magnitude of hyperkalemic response correlate to the magnitude of burn?
no
116
3 intraoperative goals burn pt
rapid and effective intravascular volume replacement (parkland formula)
low tidal volume (6mL/kg and PIP <30
minimize heat loss
117
parkland formula
(4mL)(%BSA)(kg)= volume of LR
half given first 8 hr
half given next 16 hr
118
colloids and burn pts
conflicting ideas
| could leak from intravascular space and worsen edema
119
sepsis
infection associated with
inflammatory rxn of whole body
immune response that can lead to multiple organ dysfunction syndrome
120
examples of immune response that can lead to multiple organ dysfunction
extreme vasodilation
hypoxia (mitochondrial dysfunction)
lung failure (pulm edema)
potential renal failure
121
at least 2 of 4 criteria met for pt to have SIRS (systemic inflammatory response syndrome)
temp >38
HR >90
RR >20
WBC >12
122
starts with SIRS then leads to=
SIRS+infection(sepsis), then
severe sepsis then
septic shock
123
infectious causes of sepsis
```
CNS infection
cardiovascular infection
respiratory infection
GI infection
urinary tract infection
generalized abscess
```
124
non infectious cause of sepsis
severe trauma or hemorrhage
acute systemic disease
MI, PE, pancreatitis
125
clinical implication of septic pt
massive vasodilation and hypotension
| leads to inadequate organ perfusion and lactic acidosis
126
clinical management of septic pts 4
treat source of infxn
restore perfusion with fluids and vasopressors
fix metabolic acidosis
consider steriods
127
ventilation in sepsis pt
high fiO2 low TV
128
maintenance of anesthesia in sepsis pt
MAC values decreased
| regional contraindicated
129
lab and hemodynamic goal in sepsis
```
lactate <2 mmol/L
ScvO2 >70%
CVP 8-12mmHg
MAP 65mmHg
U/O 0.5mL/kg/hr
```
