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Emergency Medicine > Blood Products and IV fluids > Flashcards

Blood Products and IV fluids Flashcards

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1
Q

What is the formula for O2 delivery?

A
  • Oxygen delivery (DO2) is determined by the formula

- DO2 = cardiac output X arterial oxygen content

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2
Q

Transfusion risks

5

A
  1. Infection
  2. Allergic and immune transfusion reaction
  3. Volume overload
  4. Hyperkalemia
  5. Iron Overload
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3
Q

Transfusion Risks

  1. Who is volume overload a common risk in? 3
  2. Hyperkalemia is a risk in which populations specifically? 3
  3. Iron overload more common in what?
A
  1. Volume overload
    - Elderly,
    - children,
    - CHF
  2. Hyperkalemia
    - Newborns,
    - renal failure,
    - massive transfusions
  3. Iron overload
    - Large number of transfusions ex: chronic anemia
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4
Q
  1. What is a massive transfusion defined as?

2. Complications? (PATCH) 5

A
  1. Defined as replacement of blood volume in a 24 hour period or >50% of blood volume in 4 hours
  2. Complications (PATCH)
    - Platelets decrease, Potassium increase
    - ARDS, Acidosis
    - Temp decrease
    - Citrate intoxication
    - Hemolytic reaction
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5
Q

Don’t forget about coagulation factors if replacing blood with PRBCs … may need a unit of what?

A

FFP

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6
Q

Type and Screen

  1. Determines what?
  2. Adverse rxn chance?
  3. Takes how long?

Type and Crossmatch

  1. Determines what?
  2. Adverse rxn risk?
  3. Takes how long?
A

Type and screen

  1. Determines ABO and Rh status and the presnce of most commonly encountered antibodies
  2. Risk of adverse reaction is 1:1000
  3. Takes about 5 minutes

Type and crossmatch

  1. Determines ABO and Rh status as well as adverse reaction to even low incidence antigens
  2. Risk of adverse reaction is 1:10,000
  3. Takes about 45 minutes
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7
Q

Depending on the clinical situation and the which society’s guidelines the range for transfusion is anywhere from Hgb of what?

A

6-10 g/dL

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8
Q

Studies indicate:
1. Target Hgb values of ______ g/dL are associated with equivalent or better outcomes in many patient populations

Compared with a target Hgb of ___ g/dL

A
  1. 7 to 8

2. 10

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9
Q

Why not transfuse before Hgb gets so low?
1. The rate of normal O2 delivery exceeds consumption by a factor of what?

  1. Theoretically (if fluid volume and cardiovascular status is maintained) O2 delivery will be adequate until the Hct reaches what?
  2. Compensatory mechanism?
    3
A
  1. 4
  2. below 10!
    • increased cardiac output,
    • rightward shift of the oxygen-hemoglobin dissociation curve
    • increased oxygen extraction
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10
Q
  1. Blood Transfusion: Decision to transfuse depends on? 4
  2. Can check what 15 min post infusion to assess status (if not actively bleeding)?
  3. If stable, consider transfusing what instead of what?
A
    • Hgb level
    • Clinical status
    • Co-morbidities
    • Patient preference
  2. Hgb/Hct
  3. one unit of packed red cells at a time (instead of multiple units in the initial order)
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11
Q

What makes up whole blood? 4

A
  1. Red cells
  2. Granulocytes
  3. Plasma
  4. Platelets
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12
Q

What makes up plasma? 2

A
  1. Fresh Frozen Plasma

2. Fractionated products

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13
Q

What makes up fractionated products? 5

A
  1. F VII
  2. F VIII
  3. F IX
  4. Albumin
  5. Immune Globin
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14
Q

FFP is made of? 2

A
  1. Cryoprecipitate
  2. Cryo supernatant plasma
    (CSP)
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15
Q
  1. When do you use FFP? 3

2. When do you transfuse platelets? 1

A
    • To replace clotting factors
    • Reverse warfarin
    • Also when you infuse a lot of packed RBC
  2. low platelet count that is symptomatic
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16
Q
  1. Which blood type is the universal donor?
  2. Which blood type is the rarest?
  3. Which blood type(s) is/are the most common?
    2
A

Which blood type is the universal donor?
1. O negative

Which blood type is the rarest?
2. AB negative (1% of the population)

Which blood type(s) is/are the most common?
3.
-O positive
-A positive

17
Q 
Crystalloids:
1. What are they?
2. Isotonic solutions: Given when?
3. Hypotonic solutions
Given to do what?
  1. Hypertonic solutions
    Given to do what?
A
  1. Solutions that contain small molecules and are able to pass through semipermeable membranes
  2. Given to expand the ECF volume
  3. reverse dehydration
  4. increase the ECF volume and decrease cellular swelling
18
Q

Colloids

  1. Solutions that contain what? 2
  2. Describe their movement?
  3. Pulling fluid out of the what for several days? 2
A
    • high molecular weight proteins or
    • starch
  2. Do not cross the capillary semipermeable membrane and remain in the intravascular space
    • intracellular and
    • interstitial space
19
Q

Remember which is a colloid vs. crystalloid:

  1. D5W, D10W, D50W?
  2. Albumin?
  3. Dextran?
  4. Saline?
  5. Combo: D5 ½ NS, D5NS, D10NS?
  6. Hexastarch?
  7. Ringer’s lactate?
A
  1. Crystalloid
  2. Colloid
  3. colloid
  4. Crystalloid
  5. crystalloid
  6. Colloid
  7. Crystalloid
20
Q
  1. Intracellular space
    - Where is it and how much of the body does it make up?
  2. Extracellular fluid includes
    - Which spaces? 2
    - Total body fluid?
A
  1. Inside the body cells
    2/3 of total body water
    • Intravascular space
    • Interstitial space
    • 1/3
21
Q

Signs and symptoms of intravascular depletion? 4

Signs and symptoms of interstitial fluid depletion? 4

A

Signs and symptoms of intravascular depletion

  1. Decreased BP,
  2. flat jugular veins
  3. Increased HR
  4. Cool extremities

Signs and symptoms of interstitial fluid depletion

  1. Decreased skin turgor,
  2. sunken eyeballs,
  3. weight
  4. Can also have hemodynamic effects
22
Q

Intravascular fluid makes up what portion of the ECF?

A

1/4 of ECF ~75 ml

23
Q

1 Liter 0.9% saline: isotonic…distributed in ECF. Why?

A

since cell membrane not permeable to sodium)

24
Q

1 liter 5% Albumin and PRBCs: remains where?

Dont give this if what?

A

remains in intravascular space

Bleeding somewhere

25
Q

How is ½ normal saline handled?

2

A

½ as free water

½ as saline

26
Q
  1. Which electrolytes are lost in sweat and exhaled water vapor?
  2. Which electrolytes are lost in the urine?
  3. Renal failure patients do not need maintenance what? 2
A
  1. none
  2. All of them
  3. Na or K
27
Q
  1. Serum sodium = what? 2
  2. Sodium is regulated by what? 3
  3. A disruption in water balance is manifested as an abnormality in what?
  4. Sodium is a functionally impermeable solute so it contributes to what? How?
A
  1. osmolality = water
    • thirst,
    • ADH, and
    • renal water handling
  3. serum sodium
  4. tonicity
    - and induces water movement across the membranes
28
Q

Which ways would we get fluid loss?
4

Fluid gain? 4

A
  1. Fluid loss
    - GI
    - Renal
    - Vascular
    - Skin
  2. Fluid gain
    - Iatrogenic
    - Heart failure
    - Liver failure
    - Kidney failure
29
Q 
A 25 year old pt presents with massive hematemesis X 1 hour.  He has a hx of peptic ulcer disease.
Exam:  Diaphoretic, normal skin turgor
Supine BP 120/70 HR 100
Sitting BP 90/50 HR 140
Serum sodium 140
  1. What kind of loss?
  2. What fluid?
A
  1. Mixed
    - Intravascular mostly though because he hasnt vomited enough stomach contents to shit the sodium
  2. NS
    of lactated ringer
30
Q

An 18 year old previously healthy male with severe diarrhea and vomiting X 48 hours
Exam: sunken eyeballs, poor skin turgor, dry mucous membranes
BP 80/60 HR 130 supine
Labs: Na 148, K 2.8, HCO3 22

  1. What kind of loss?
  2. What would we replace with?
A
  1. Extracellular
    Hypernatremia
    Hypokalemia
  2. Crystalloid
    NS + 20K
    Lactated Rinegr
31
Q

An 85 year old female nursing home resident with known dementia presents with worsening confusion. Hx significant for diabetes.
Exam: disoriented, decreased skin turgor
BP 110/70 supine; 90/70 sitting
Labs: Na 150, Hct 45, BUN/Cr 50/1.8, blood glucose 1200

  1. How would we treat?
  2. What would K be?
A
  1. Insulin drip and massive fluid replacement. NS because you have to give so much
  2. Hyperkalemia
32
Q

Rules of Fluid Replacement

  1. Replace blood with?
  2. Replace plasma with?
  3. Resuscitate with? 2
  4. Replace ECF depletion with?
  5. Rehydrate withwhat if you want the fliud distributed to all the body compartments?
A
  1. Replace blood with blood
  2. Replace plasma with colloid
  3. Resuscitate with
    - colloid
    - Ringer’s
  4. Replace ECF depletion with saline
  5. Rehydrate with dextrose if you want the fluid distributed to all body compartments

Emergency Medicine (26 decks)

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