Blood And Fluid Flashcards
One unit of PRBCs raises the Hct by _____ %?
3%
Identify the areas of the upper extremities that are at high risk for developing position related nerve damage?
Ulnar Neuropathy, Brachial Plexus, Radial and median nerve
Most common ocular injury?
Corneal Abrasion
main complication with the supine lithotomy position?
Airway Obstruction and decreased Tidal Volumes
In the supine position abdominal contents cause a decrease in the patients ________?
Functional Residual Capacity (FRC) by 25%
The ________ lies in close proximity to the fixed first rib, clavicle and humerus and is predisposed to compression.
Brachial plexus
The number one nerve injury related to positioning involve the _______?
Ulnar Nerve
The classic site of injury to the ulnar nerve is?
Behind the ulnar groove behind the medial epicondyle of the humerus
This position is associated with the greatest number of ocular injuries?
Lateral
When supine the arms should not be abducted greater than ______ degrees and the wrist should be _______?
90, supinated (palms up)
Trendelenberg postion affects the body in what manner?
Increase: CVP, ICP, Intraocular pressure
Decrease: FRC and Pulmonary compliance
4 ways to avoid a Brachial Plexus injury?
Keep Head Midline
Arms kept at < 90 degrees
Elbows mildly flexed
Use a non-sliding mattress for Trendelenburg
Reverse trendelenberg affects the body in what manner?
Decreases venous return
What is the biggest concern for a patient in the sitting position?
Air embolism
what is the best way to detect a air embolism?
Esophageal stethoscope
3 goals of positioning?
Maximum exposure for the surgeon
Access to the patient for ventilation and monitoring
Promote satisfactory surgical results
Greater then ______ hours for surgery increase position related injuries?
4-5 hours
_________ accounts for 89% of all postop visual loss?
Ischemic optic neuropathy (ION)
1 Unit of PRBCs raises the Hgb _______ ?
1 gm
FFP is viable for _____ and has a volume of ______ ?
1 yr, 200-250 ml
1 unit of Platelets increase the count by____?
5,000 - 10,000
For every 4 units of PRBCs give ________?
1 unit of FFP
For every 8 units of PRBCs give ______, _______?
2 units of FFP, 4 pack of Platelets
Autologous blood can be obtained by ____, ____, _____?
Predepositing, Hemodilution (removing 1-2 units immediately intraoperatively), Post-op Salvage
_____ is the % of red cells to the total volume of blood?
HCT
TRALI stands for?
Transfusion Related Acute Lung Injury
In an anesthetized Pt with a NMBA on board. The most likely signs we will see of a transfusion reaction are ____, ____, ____?
Free Hgb in the Urine, increase in airway peak pressures and elevation in temp
________ is the second most common transfusion reaction?
Transfusion Related Acute Lung Injury (TRALI)
Albumin 5% replaces volume in a ___ to ___ ratio?
1 to 1
Albumin 25% expands volume by _____ and within _____ minutes?
2.5 - 5 times and within 15 minutes
Most common reason for coagulopathies are?
Lack of functioning Platelets
What is considered an acceptable urinary output?
0.5ml/kg/hr
What is the formula for calculating maintenance fluid?
4 ml/kg/hr for the first 10kg
For the next 10-20 kg add 2 ml/kg/hr
for each kg above 20 add an additional 1 ml/kg/hr
Most common transfusion reaction is?
Febrile
Types of transfusion reactions are?
Febrile, Allergic, Hemolytic
what genetic disease benifits from the administration of cryoprecipitate?
Hemophilia A ( factor VIII deficient)
What is the Hct of 1 unit of PRBCs?
70% Hct 250 ml’s
Calculate the allowable blood loss if the Hct is 40 and allowable blood loss to a Hct of 30 in a 80 kg male Pt.
Estimated Blood volume: 75ml x 80kg= 6000ml. RBCV40%= 6000x0.4=2400 RBCV30%= 6000x0.3=1800 2400-1800=400ml allowable blood loss =3x400=1200 ml
Average blood volume per kg for female is?
65 ml/kg
Average blood volume per kg for male is?
70-75 ml/kg
Intraoperative fluid replacement for insensible loss is?
2 ml/kg
Intraoperative fluid replacement for minimal surgical trauma is?
2-4 ml/kg
Intraoperative fluid replacement for severe surgical trauma is?
6-8 ml/kg
Intraoperative fluid replacement for moderate surgical trauma is?
4-6 ml/kg
For every 1 ml blood loss replace it with ____ ml of crystalloid?
3 ml
Treatment of Hyperkalemia could entail?
Hyperventilation, IV Calcium, or D50 Insulin and bicarb
Citrate in PRBC units contribute to _____ and _____?
Metabolic Alkalosis and Hypocalcemia
Blood stored accumulates ___, ___ and decreases in ____?
H+ ions, K+ and decreases in 2,3 DPG
1 liter of LR contains what electrolytes and how much?
Na 130mEq, Cl 109mEq, K 4mEq, Ca 3 mEq, Lactate 28 mEq
1 liter of Normal Saline contains what electrolytes and how much
Na 154 mEq and Cl 154 Meq
Advanced Trauma Life Support (ATLS) Classification 1 R/T Blood loss?
750 ml or less, HR <100, BP normal, RR normal, Blanch ok, UOP normal, Anxious
Replace with crystalloid.
Advanced Trauma Life Support (ATLS) Classification 2 R/T Blood loss?
750-1500 ml, HR >100, BP normal, RR 20-30, Blanch + , UOP 20-30, Anxious
Replace with crystalloid
Advanced Trauma Life Support (ATLS) Classification 3 R/T Blood loss?
1500-2000 ml, HR >120, BP decreased, Blanch + , UOP 5-15, Anxious and confused
Replace with crystalloid and blood
Advanced Trauma Life Support (ATLS) Classification 4 R/T Blood loss?
> 2000 ml, HR >140, BP decreased, RR >35, Blanch + , No UOP, Anxious and confused and lethargic
GIVE BLOOD and crystalloid
A soaked 4x4 is equal to ____ ml?
10 ml
A soaked Lap pad is equal to ____ ml?
100-150 ml
Platelets are usually given when the count is less then _______?
50,000
Crystalloid intravascular half-life is?
20-30 min
Colloid intravascular half-life is between ____?
3-6 hrs
NPO deficit is given how much the first, second, and third hour?
1st hour give 1/2 the total NPO deficit
2nd hour give 1/4 the total NPO deficit
3rd hour give 1/4 the total NPO deficit
General rule of thumb after how many units of PRBCs do you give Ca+?
2 units
