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Methods of Anesthesia > Advanced Fluid Management > Flashcards

Advanced Fluid Management Flashcards

1
Q

Intravascular hydrostatic pressure drives fluid ___ blood vessels

A

out of

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2
Q

Interstitial hydrostatic pressure drives fluid ____ blood vessels

A

into

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3
Q

Intravascular oncotic pressure pulls fluid ___ blood vessels

A

into

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4
Q

Interstitial oncotic pressure pulls fluid ___ blood vessels

A

out of

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5
Q

What leads to edema?

A

Decreased intravascular oncotic pressure

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6
Q

How does edema occur in pregnancy?

A

Plasma volume increases, plasma albumin concentration decreases, capillary oncotic pressure decreases, fluid in the interstitial space increases

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7
Q

Helps maintain fluid balance and protects the body from producing WBCs from lymphocytes

A

Lymphatic system

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8
Q

Number of osmoles per kg

A

Osmolality

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9
Q

Number of osmoles per liter

A

Osmolarity

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10
Q

Plasma osmolarity

A

280-290 mOsm/L

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11
Q

What regulates osmolarity?

A
  1. Hypothalamus
  2. Carotid baroreceptors
  3. kidneys
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12
Q

Has a higher concentration of total solutes than other side of the membrane

A

Hyperosmolar

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13
Q

Has a lower concentration of total solutes than other side of the membrane

A

Hypoosmolar

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14
Q

Means water moves toward the solution

A

Hypertonic

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15
Q

Means water moves away from the solution

A

Hypotonic

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16
Q

Osmolarity of a hypertonic IV solution

A

> 375 mOsm/L

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17
Q

What happens to a patient that receives hypertonic IV fluid?

A
  1. The cells of the body shrink

2. Blood volume increases/expands

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18
Q

Examples of hypertonic IV solutions

A
  1. Mannitol
  2. 3% NS
  3. D5 solutions (except D5W)
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19
Q

How much dextrose is in a D5 solution?

A

5%

50mg/mL

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20
Q

How much dextrose is in a D50 solution?

A

50%

500mg/mL

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21
Q

Dextrose doses for hypoglycemia

A 
Pediatric = 0.25-0.5 g/kg
Adult = 0.5-1 g/kg
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22
Q

How many grams of glucose are in 1 amp (50ml) D50?

A

25g

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23
Q

How many grams of glucose are in 1000mL D5W?

A

50g

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24
Q

How many grams of glucose is 500 mL D5W?

A

25g

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25
Q

Indications for hypertonic IV fluids

A
  1. 3% NS can be indicated to correct hyponatremia
  2. Glucose solutions to treat hypoglycemia
  3. Mannitol can increase renal perfusion and diuresis or decrease ICP
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26
Q

Complications of hypertonic IV fluids

A
  1. Brain cells can shrink and cause “central pontine myelinolysis” and death
  2. Osmotic diuresis, loss of electrolytes, intracellular dehydration and coma
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27
Q

Osmolarity of hypotonic IV solution

A

<250 mOsm/L

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28
Q

Effects of hypotonic solutions

A
  1. Cells expand

2. Blood volume decreases

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29
Q

Examples of hypotonic IV fluids

A
  1. D5W after glucose metabolizes
  2. 0.45% NS
  3. 2.5% dextrose in water
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30
Q

Indications for hypotonic IV fluids

A
  1. hypernatremia
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31
Q

Complications with hypotonic fliuds

A
  1. Phlebitis (administer through central line if possible)

2. Cerebral edema if large volumes are administered

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32
Q

Osmolarity of isotonic solution

A

250-375 mOsm/L

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33
Q

Examples of isotonic solutions

A
  1. LR
  2. NS 0.9%
  3. Normosol/Plasmalyte
  4. 5% albumin
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34
Q

Osmolarity of LR

A

273 mOsm/L

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35
Q

Contents of LR

A

Na+, K+, Ca+2, Cl-, lactate

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36
Q

Contraindications to lactated ringers

A
  1. Liver disease/liver failure (lactate is converted to bicarb by the liver)
  2. Neurosurgery and/or patients with increased ICP
  3. W/rocephin in newborns
    4? Metabolic alkalosis/pyloric stenosis
    5? giving blood
    6? diabetes
    7? renal failure
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37
Q

Osmolarity of 0.9% NS

A

308 mOsm/L

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38
Q

Amount of sodium in 1 L of 0.9% NS

A

154 mEq

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39
Q

Administration of large volumes of NS leads to

A

Non-anion gap metabolic acidosis

40
Q

Contents of plasmalyte

A

K+, Mg+2, Cl-

41
Q

Osmolarity of plasmalyte

A

294 mOsm/L

42
Q

Indications for plasmalyte

A
  1. Blood transfusions

2. Liver failure

43
Q

Preferred fluid in patients with metabolic acidosis

A

Plasmalyte, it has 50 mEq bicarb per L compared to 28 mEq/L in LR

44
Q

Contraindications for plasmalyte

A

None

45
Q

Most common colloid used in the OR for treating hypovolemia patients

A

5% albumin

46
Q

When are 20 and 25% albumin considered?

A

In large blood volume deficit or an oncotic deficit resulting from hypoproteinemia

47
Q

Colloid used as an alternative to albumin

A

Hespan (6% Hetastarch)

48
Q

What is the black box warning for hespan?

A

Increased mortality and severe renal injury in critically ill adult patients, as well as increased risk of bleeding with use of CPB

49
Q

Circulating blood volume for preterm infant

A

90-100 mL/kg

50
Q

Circulating blood volume for pregnant patient at term

A

90-100 mL/kg

51
Q

Circulating blood volume for full term neonate

A

90 mL/kg

52
Q

Circulating blood volume for infants

A

80 mL/kg

53
Q

Circulating blood volume for adult males

A

70-75 mL/kg

54
Q

Circulating blood volume for adult females

A

60-65 mL/kg

55
Q

Circulating blood volume for elderly and obese

A

15% less than adults

56
Q

Total body water in healthy males

A

60%

57
Q

Total body water in obese males

A

50%

58
Q

Total body water in geriatric males

A

50%

59
Q

Total body water in healthy females

A

50%

60
Q

Total body water in obese females

A

40-45%

61
Q

Total body water in geriatric females

A

40-45%

62
Q

Total body water in neonates

A

80%

63
Q

Total body water in infants

A

70%

64
Q

1st step of total body water

A

1 L of water = 1 kg

65
Q

Percentage of TBW that is intracellular fluid

A

65%

66
Q

Percentage of TBW that is extracellular fluid

A

35%

67
Q

Percentage of extracellular fluid that is interstital

A

70-75%

68
Q

Percentage of extracellular fluid that is intravascular

A

25-30%

69
Q

Percentage of TBW that is interstitial fluid

A

25%

70
Q

Percentage of TBW that is intravascular fluid

A

10%

71
Q

Complication of acetazolamide

A

It is a carbonic anhydrase inhibitor, causing patients to urinate bicarbonate, causing metabolic acidosis

72
Q

Uses for acetazolamide

A
  1. Diuretic for heart failure related edema
  2. Treat glaucoma and lower intraocular pressure
  3. Treat altitude sickness
73
Q

Uses for lasix

A
  1. Fluid overload
  2. Chronic hypertension
  3. Offsetting increased production of ADH during surgery
74
Q

True/false. Lasix is renal protective

A

False

75
Q

Causes diuresis through increased blood flow to the kidney

A

Mannitol

76
Q

Kidney disorder that causes the body to excrete too much protein in the urine

A

Nephrotic syndrome

77
Q

Symptoms of nephrotic syndrome

A
  1. Proteinuria
  2. Hypoalbuminemia
  3. Fluid overload (edema)
78
Q

Treatment for nephrotic syndrome

A

Treat underlying conditions

79
Q

Percentage to classify a major burn injury in adults

A

> 20% or face, airway, and/or genitalia are burned

80
Q

Percentage to classify a major burn injury in kids and elderly patients

A

> 10% or face, airway, and/or genitalia are burned

81
Q

TBSA for burns on a child compared to an adult

A

9% more in the head
8% less in the legs
1% less in the genitalia

82
Q

Physiology of patients after thermal injury (9)

A
  1. Hypovolemia and decreased cardiac output
  2. Massive leak of fluid and electrolytes from intravascular space into interstitial space (edema, hypovolemia)
  3. Hypothermia
  4. Anemia and thrombocytopenia
  5. Hypercoaguable state
  6. Proliferation of nicotinic receptors after 24 hours
  7. Possible acute renal failure
  8. Altered pulmonary physiology
  9. Hypermetabolic phase
83
Q

What causes hypovolemia and decreased cardiac output in burn patients?

A
  1. Drainage and evaporation from burn wounds

2. An intense inflammatory response, leading to vasodilation and increased capillary permeability

84
Q

Proliferation of nicotinic Ach receptors causes:

A
  1. Resistance to nondepolarizers

2. Sensitivity to Sux

85
Q

What happens with hypermetabolic phase in patients with a burn injury?

A
  1. Massive surge in catecholamines and corticosteroids
  2. Increased myocardial oxygen consumption and work
  3. Insulin resistance
  4. Fever
  5. Liver dysfunction
86
Q

First priority after thermal injury

A

Immediate airway assessment

87
Q

Safest intubation option

A

Awake fiberoptic intubation with maintenance of spontaneous ventilation

88
Q

Why are lower drug doses required in the initial burn shock phase? (1st 48 hours)

A

Renal and hepatic flow is decreased
-vasodilation and increased vascular permeability lead to large fluid shifts to the interstitial space, leading to low blood volume, increased hematocrit and low cardiac output

89
Q

Drug dosing requirements in the hypermetabolic phase (48-72 hours)

A

MAC requirements are higher

Fluid overload can lead to higher drug dosing requirements

90
Q

Succinylcholine guidelines for burns

A
  1. Can be safely administered within 24 hours
  2. Should be avoided for 24-48 hours after thermal injury
  3. May consider using 1-2 years after thermal injury occurred
91
Q

Intraoperative goals for thermal injury

A
  1. Rapid and effective intravascular volume replacement
  2. Low tidal volumes should be used with mechanical ventilation (6ml/kg Vt and <30cmH2O PIP)
  3. Efforts to minimize heat loss should be implemented
92
Q

What is the parkland formula for burn patients?

A

4 ml/kg LR per percentage of TBSA burned within the first 24 hours
-first half of the volume should be administered within the first 8 hours

93
Q

Are colloids useful for burn resuscitation?

A

No, they can cause the vessels to become so vasodilated that they leak

94
Q

Potential infectious causes of sepsis

A
  1. CNS infections
  2. Cardiovascular infections
  3. Respiratory infections
  4. Gastrointestinal infections
  5. UTIs
  6. Generalized abscesses
95
Q

Potential non-infectious causes of sepsis

A
  1. Severe trauma or hemorrhage

2. Acute systemic disease (MI, PE, pancreatitis)

Methods of Anesthesia (20 decks)

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