Anaesthesia And Fluids Flashcards

1
Q

What is normal serum osmolarity

A

275 - 295 mOsm/L

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2
Q

Why is normal saline not routinely given in fluid resuscitation, especially septic patients? (3)

A
  • hyperchloremic metabolic acidosis
  • renal dysfunction
  • mesenteric hypoperfusion
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3
Q

Which group of fluids is contraindicated in shock?

A

Hydroxyethyl starches aka voluven. Type of synthetic colloid

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4
Q

Resuscitation fluid indications and examples?

A

To provide plasma volume expansion and improve tissue perfusion . needs to contain sodium. Isotonic
Eg ringer’s, plasmalyte B

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5
Q

Maintenance fluid indications and examples?

A

Provide basic daily requirements of water, electrolytes and some caloric support in patients unable to use oral intake route
Eg 5-10 % maintelyte

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6
Q

Rehydration fluid indications and examples?

A

Indicated purely to restore water deficits. Electrolytes have to be added depending on specific deficits
Eg rehydration solution, 5% dextrose

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7
Q

Replacement redistribution fluid indications and examples?

A

Assist with daily balance of water by adding or subtracting from maintenance needs in cases with superimposed loses or excesses
Eg ringer’s, plasmalyte B

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8
Q

Name 3 classes of fluids and 3 examples of each

A

• Crystalloid’s.: ringers lactate, 0,9% Nacl normal saline, plasmalyle B (balsol), maintelyte 5-10%, 5 and 10% dextrose in water, 5 % Hypertonic saline, rehydration solution, 1/2 dd (half Darrows and dextrose Paeds) , neonatalyte
. synthetic colloids: starches HES (voluven., volulyte) and gelatine (gelofusine)
• natural colloids: human albumin 4 % (albusol), blood components (RC, FFP, platelets, freeze dried plasma), especial fractions (cryoprecipitates, factor concentrates eg haemosolvate, haemosolvex, immunoglobulins

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9
Q

State the composition (Na, Cl, k, buffer, ca, mg, glucose, pH, osmolality ) of plasma

A
• Na 135 - 145
•cl 95-105
. K 3,5-5,3
• buffer hco3 24-32
• Ca 2,2-2,6
. Mg 0,8-1,2
• glucose 3,5-5,5
• ph 7,35-7,45
.0sm 275-295
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10
Q

State the composition (Na, Cl, k, buffer, ca, mg, glucose, pH, osmolality ) of ringers lactate and uses

A
• Na 130 ( slightly less than plasma)
• cl 109 (slightly more than plasma)
. K 4
. Buffer lactate 28
• Ca 1,4 (slightly less than plasma)
• ph 6-7,5
• Osm 273 (slightly less than plasma)
Used for resus and replacement
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11
Q

State the composition (Na, Cl, k, buffer, ca, mg, glucose, pH, osmolality ) of plasmalyte B and uses

A
• Na 130
• cl 110 (slightly more than plasma)
•K 4
. Buffer hco3 27-28
. Mg 1,5 (slighty more than plasma)
• ph 7, 4
. Osm 273
Used for resuscitation and replacement
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12
Q

State the composition (Na, Cl, k, buffer, ca, mg, glucose, pH, osmolality ) of maintelyte 5%

A
• Na 35 (much less than plasma)
• cl 65 (much less than plasma)
• K 25 (much more)
• mg 2,5 (slightly more than plasma)
• Glucose 50 g (much more )
• Ph 4 (much less)
• Osm 405 ( much more)
Used for maintenance
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13
Q

What are normal daily water, electrolyte, proteins and glucose requirements?

A

Water 30-50 ml /kg/day
Na, cl, k 1 mmol/kg/day
50-100 g/day glucose (about 2000 cal)
Proteins 1,5 g/kg per day ( 2g needed in hypercatabolic patients)

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14
Q

When should maintenance fluids be prescribed and which is the preferred fluid and dose?

A

When patient can’t meet daily water and caloric needs orally but doesn’t have any added loses or excesses
Maintelyte 5% 60-80 ml per hour

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15
Q

Consequences of gastric fluid loses eg aspirate, fistula, vomiting?

A

Hypochloraemic metabolic alkalosis
Low Na, cl, K
High hco3

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16
Q

Consequences of fluid loses by pancreatic fistula?

A

Hyponatraemic hypokalaemia metabolic acidosis
Low na, k, hco3
Normal cl

17
Q

Consequences of fluid loses by small bowel enterocutaneous fistula?

A

Hyponatraemic hypokalemic metabolic acidosis

Low na, cl, k, hc03

18
Q

Consequences of fluid loses by biliary fistula?

A

Alkalosis may occur
Low na, cl, K
Normal hco3

19
Q

Consequences of fluid loses by diarrhoea?

A

Hyperchloraemic metabolic acidosis ( non anion gap)
High na, cl, hco3
Low K

20
Q

What is the common protocol for fluid replacement?

A

• Quantify 6 hourly water loses then replace using nacl containing crystalloids (ringers, plasmalyte B) to admin equal volume = 1:1. formula
Eg ECF loosing 450ml every 6 hours, then add 450 ml ringers to maintenance every 6 hours to keep water balance.

21
Q

How often should electrolytes and CMP be monitored when practicing fluid maintenance?

A

Daily

22
Q

Blood products ratio used?

A

4 RCC: 4 FFP: 1 mu platelets

23
Q

Which induction agents use for trauma patients?

A

Etomidate or ketamine

24
Q

Which maintenance agents use for trauma patients?

A

Ketamine

25
Q

When is the only time normal saline would be given for resusc?

A

Confirmed or suspected TBI and cerebral oedema because isotonic

26
Q

What is the modified Parkland formula for burns

A

3-4 ml / kg/ % burn / 24 hours of ringers
1/2 in first 8 hours from time of injury
Second 1/2 in next 16 hours

27
Q

What is tramadol?

A

Opioid analgesic

28
Q

Tramadol moa?

A

Nonselective pure agonist at mu, kappa, delta opiate receptors with noradrenergic and serotonergic reuptake inhibition

29
Q

Paeds fluid resuscitation principles? Type fluid and dose

A

Crystalloid’s 10ml /kg up to Max 40

After 40, give blood

30
Q

Ratio packed red cells to FFP to platelets in children <30 and >30 kg?

A

<30 1:1:1

>30 3:2:1

31
Q

Rule of thumb for paedatric weight estimation?

A

Age x2 +8

32
Q

How much anti -d should be given to Rh negative mothers who have sustained trauma?

A

30omg

33
Q

For which snakes can the SAIMR polyvalent antivenom be used?

A
Marc
Mamba x3
Adders X2-puff and gaboon
RinkHals
Cobra x4