Chapter 1 Flashcards
What are the components of the “AMPLE” mnemonic for gathering relevant history prior to a surgery?
Allergies Medications Past medical history Last meal Events prior to onset
Should patients with CKD receive IVFs in case of septic shock?
Yes
Should patients who have CKD be protein restricted perioperatively to preserve kidney function?
No–worsens acidosis
If patients are given more than how many mEq per hour of K, should they be placed on cardiac monitoring?
10 mEq/hr
What is the 4:2:1 rule of administering fluids?
Maintenance fluid per hour is
4 mL / kg for the first 10 kg
2 mL / kg for the second 10 kg
1 mL / kg for each remaining kg
What is the rule for administering maintenance fluids for elderly patients?
25 mL/ kg
What causes the increased urine output 3 or so days following surgery?
Mobilization of water from the wound into the intravascular space
Why is there hypokalemia with large gastric losses of fluid?
Loss of Cl causes kidneys to hold on to Na more tightly, and as a result excrete K
What is the formula for FeNa?
FeNa = [UNa × PCR)/(PNa × UCr) × 100].
What value of FeNa is characteristic of prerenal, and renal azotemia?
Less than 1% is prerenal
More than 2% is postrenal
a BUN:Cr ratio of what value indicates prerenal azotemia?
20:1
An increase in HR of (__) or increases in SBP of (__) should raise suspicion of hypovolemia.
10 bpm
15 mmHg
Why should dextrose solutions never be used in patients that are hemodynamically unstable in their stabilization?
Will cause osmotic diuresis
Volume losses are replaced with (___), while blood losses are replaced with (___)
Volume = NS Blood = LR
Which is preferred for large volume resuscitation: LR or NS? Why?
LR, since NS will result in hyperchloremia
Pontine demyelination results from what?
Too rapid a correction of hypernatremia
What is the goal urine output for adults in children that have no underlying renal issues?
- 5 mL/kg for adults
1. 0 mL/kg for children
What is the amount of hemoglobin that necessitates blood transfusion?
7 g/dL
Are patients with sepsis volume overloaded?
No–just spread to the periphery. Actually, there is an intravascular volume depletion.
How can you tell if a patient with sepsis is intravascularly volume depleted?
Hemodynamically unstable
Does hyper or hyponatremia result with an infusion of mannitol?
Hyponatremia, since water is pulled out of cells to dilute new excess sodium
What is the general rule for replacing water loss in hypernatremia?
Serum sodium increases 3 mEq above the normal value of 140 for every liter of water lost
What type of fluid is used for mild, moderate, and severe levels respectively.
- 0.9% NS for mild
- 0.45% NS for moderate
- 0.9% NS for severe (since the patient usually has a vascular volume deficit in addition to a total body water deficit)
Which is the first priority: treating hypovolemia or hypernatremia
Hypovolemia