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Methods of Anesthesia II > Advanced Fluid Management > Flashcards

Advanced Fluid Management 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

decreased intravascular oncotic pressure can lead to what

A

edema

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8
Q

why is there edema in pregnancy

A

plasma volume increases
albumin conc decreases
intravascular oncotic pressure decreases

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9
Q

why is there edema in liver failure

A

plasma albumin conc decreases bc of decreased albumin synthesis
decreased intravascular oncotic pressure

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10
Q

capillary arterial end net filt pressure and direction

A

net filtration pressure of 13 OUT of blood vessels

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11
Q

venous end net filt pressure and direction

A

net filtration pressure 7

INTO blood vessels

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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

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13
Q

lymphatic system function

A

maintain fluid balance

protect body from infection

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14
Q

moles

A

refer to compounds

NaCl

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15
Q

osmoles

A

refer to ions

Na+ Cl-

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16
Q

osmolality

A

number osmoles/kg solvent

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17
Q

osmolarity

A

number osmoles/L

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18
Q

plasma osmolarity

A

280-290 mOsm/L

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19
Q

what 3 things regulate osmolarity

A

hypothalamus
carotid baroreceptors
kidneys

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20
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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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

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22
Q

molarity

A

how concentrated one solution is compared to another

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23
Q

hyperosmolar

A

higher conc of total solutes than other side of membrane

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24
Q

tonicity

A

which direction water moves

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25
Q

hypertonic

A

water moves toward the solution

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26
Q

hypertonic IV solution definition

A

osmolarity of >375 mOsm/L

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27
Q

effects of hypertonic IV solution on the body

A

cells of the body shrink

blood volume increases

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28
Q

3 hypertonic IV solutions

A

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

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29
Q

mEq/L of 3% N/S

A

513 mEq/L

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30
Q

D5 solution

A

5% dextrose in bag or vial

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31
Q

D50 solution

A

50% dextrose in bag or vial

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32
Q

5% dextrose is what mg/mL?

A

50mg/mL

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33
Q

50% dextrose is what mg/mL

A

500mg/mL

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34
Q

pediatric dose of dextrose

A

0.25-0.5g/kg

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35
Q

adult dose of dextrose

A

0.5-1g/kg

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36
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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37
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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38
Q

hypotonic IV solution definition

A

osmolarity of <250mOsm/L

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39
Q

effects of hypotonic IV fluids on the body

A

cells of the body will expand

blood volume decreases

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40
Q

3 hypotonic solutions

A

0.45% N/S
2.5% Dextrose in Water
D5W

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41
Q

is D5W really hypotonic?

A

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

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42
Q

indications for hypotonic IV fluids

A

hypernatremia

water deficit

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43
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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44
Q

isotonic solution definition

A

osmolarity of 250-375 mOsm/L

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45
Q

4 types of isotonic solution

A

LR
N/S .9%
normosol
5% albumin

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46
Q

osmolarity of LR

A

273 mOsm/L

slightly hypotonic

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47
Q

contents of LR

A

Na, K, Ca, Cl, lactate

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48
Q

what is lactate converted to by the liver?

A

bicarb and glucose

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49
Q

5 contraindications to LR

A 
hanging with blood?
liver disease/failure
brain surgery
diabetes?
renal failure?
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50
Q

why not hang LR with blood

A

calcium could chelate the citrate anticoagulant preservative and form clots

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51
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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52
Q

why avoid LR in diabetes?

A

lactate is converted to glucose and exacerbates hyperglycemia

53
Q

why avoid LR in renal failure?

A

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

54
Q

osmolarity of .9% N/S

A

308 mOsm/L

slightly hypertonic

55
Q

each L of .9% N/S contains how much mEq of sodium?

A

154mEq

56
Q

what can large volumes of N/S .9% administration lead to?

A

non anion gap metabolic acidosis

57
Q

osmolarity of normosol

A

294 mOsm/L

58
Q

contents of normosol

A

Na, K, Mg, Cl

  • doesnt have lactate or calcium
59
Q

potassium conc in normosol

A

5mEq/L

60
Q

potassium conc in LR

A

4mEq/L

61
Q

indications for plasmalyte

A

blood transfusions

liver failure

62
Q

conc bicarb normosol

A

50mEq/L

63
Q

conc bicarb LR

A

28mEq/L

64
Q

contraindications for normosol

A

none

65
Q

most common colloid used in hypovolemic pts

A

5% albumin

66
Q

5% albumin will expand the intravascular volume how much?

A

mL for mL

67
Q

Hespan

A

colloid used as alternative to albumin

68
Q

what is the risk with hespan

A

black box warning increased mortality

69
Q

when would you use hespan?

A

allergy to albumin

jehovah witness

70
Q

Blood volume preterm infant

A

90-100mL/kg

71
Q

blood volume full term neonate

A

90mL/kg

72
Q

blood volume infant

A

80mL/kg

73
Q

blood volume male

A

70-75mL/kg

74
Q

blood volume female

A

60-65mL/kg

75
Q

blood volume elderly & obese

A

~15% less than adults

76
Q

TBW males: healthy, obese, geriatric

A

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

77
Q

TBW females: healthy, obese, geriatric

A

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

78
Q

TBW neonate

A

80%

79
Q

TBW infant

A

70%

80
Q

intracellular fluid % of TBW

A

65%

81
Q

extracellular fluid % of TBW

A

35%

82
Q

interstitial fluid % of extracellular fluid and TBW

A

extra- 75%

TBW 25%

83
Q

intravascular fluid % of extracellular fluid and TBW

A

extra- 25%

TBW 10%

84
Q

lasix

A

loop diuretic

inhibits water and sodium reabsorption in LOH

85
Q

indications for lasix 3

A

fluid overload
chronic HTN
offsetting increased ADH in surgery

86
Q

is lasix renal protective or increase renal blood flow?

A

no

87
Q

mannitol

A

osmotic diuretic

increases osmolarity of blood, expands plasma volume

88
Q

mannitol indications

A

renal protection and perfusion

brain surgery

89
Q

does mannitol increase renal perfusion?

A

yes

90
Q

spirolactone

A

usually at home mediations

potassium sparing

91
Q

acetazolamide

A

carbonic anhydrase inhibitor

decrease bicarb and increase PaCO2

92
Q

complication of acetazolamide

A

metabolic acidosis

93
Q

indications for acetazolamide

A

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

94
Q

nephrotic syndrome

A

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

95
Q

2 symptoms of nephrotic syndrome

A

proteinuria
hypoalbuminemia
fluid overload (edema)

96
Q

treatment for nephrotic syndrome

A

finding and fixing underlying cause

97
Q

adult major burn definition

A

> 20% of TBSA

98
Q

kids and elderly major burn definition

A

> 10% TBSA

99
Q

what things make it a major burn regardless of TBSA?

A

burn to face
airway
genitalia

100
Q

describe rule 9

A 
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
Q

physiology of pts after thermal injury 9

A 
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
Q

why is there hypovolemia and decreased CO in burn pts

A

drainage and evaporation from wounds

intense infammatory response leads to vasodilation

103
Q

what does the increased capillary permeability and massive leak of fluids lead to?

A

hypovolemia, hypotension, burn shock

massive edema in all tissue

104
Q

how is anemia and throbocytopenia caused in burn pts

A

bleeding from wounds
heat damage to RBC
fluid resuscitation

105
Q

proliferation of nicotinic ach receptors causes what?

A

resistance to nondep

sensitivity to succ

106
Q

possible complications of altered pulm physiology include

A

decreased pulm compliance
increased lung vascular and permeability and PVR
possible carbon monoxide poisoning

107
Q

what is the hypermetabolic phase caused by

A

massive surge of catecholamines and corticosteriods

108
Q

what does the hypermetabolic phase lead to?

A

increased myocardial oxygen demand
insulin resistance
fever
liver dysfunction

109
Q

when does the hypermetabolic phase develop?

A

can take several weeks

110
Q

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

A

airway assessment
potential intubation
awake fiberoptic best

111
Q

when should you promptly intubate a burn pt

A

burns to face
neck
upper chest
inhalational burns

112
Q

drug dosing initial burn shock phase (48hr)

A

vasodilation and low cardiac output = lower drug doses

113
Q

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

A

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

114
Q

succ in burn pts

A

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

115
Q

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

A

no

116
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

117
Q

parkland formula

A

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

118
Q

colloids and burn pts

A

conflicting ideas

could leak from intravascular space and worsen edema

119
Q

sepsis

A

infection associated with
inflammatory rxn of whole body
immune response that can lead to multiple organ dysfunction syndrome

120
Q

examples of immune response that can lead to multiple organ dysfunction

A

extreme vasodilation
hypoxia (mitochondrial dysfunction)
lung failure (pulm edema)
potential renal failure

121
Q

at least 2 of 4 criteria met for pt to have SIRS (systemic inflammatory response syndrome)

A

temp >38
HR >90
RR >20
WBC >12

122
Q

starts with SIRS then leads to=

A

SIRS+infection(sepsis), then
severe sepsis then
septic shock

123
Q

infectious causes of sepsis

A 
CNS infection
cardiovascular infection
respiratory infection
GI infection
urinary tract infection
generalized abscess
124
Q

non infectious cause of sepsis

A

severe trauma or hemorrhage
acute systemic disease
MI, PE, pancreatitis

125
Q

clinical implication of septic pt

A

massive vasodilation and hypotension

leads to inadequate organ perfusion and lactic acidosis

126
Q

clinical management of septic pts 4

A

treat source of infxn
restore perfusion with fluids and vasopressors
fix metabolic acidosis
consider steriods

127
Q

ventilation in sepsis pt

A

high fiO2 low TV

128
Q

maintenance of anesthesia in sepsis pt

A

MAC values decreased

regional contraindicated

129
Q

lab and hemodynamic goal in sepsis

A 
lactate <2 mmol/L
ScvO2 >70%
CVP 8-12mmHg
MAP 65mmHg
U/O 0.5mL/kg/hr

Methods of Anesthesia II (13 decks)

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