class notes

Question 1

pancreatitis

Answer 1

= to fluid loss of a 30% burn pt

Question 2

crystaloid fluids

Answer 2

-IV fluids
-come in bags/bottles
-used for resuscitation
-too much crystaloid fluids -> edema
-younger people -> can handle fluids
-elderly -> flood -> pleural effusion, CHF, a fib!!!! -> post op decrease fluids

-you can give this to suck fluid out of brain cells -> decrease edema of brain -> decrease ICP

Question 3

garden hose theory

Answer 3

-arterial side that delivers pressure
-if there is a leak on the high side of pressure -> amount of fluid loss is much greater closer to the high pressure area
-protein in the hose pull the fluid back into the hose -> oncotic pressure
-hydrostatic pressure push things out
-lymphatics drain interstitial fluid
-pitting edema
-cancer edema is not pitting

-if you have liver problems -> not enough proteins (albumin) -> decrease oncotic pressure -> edema
-if diabetic and losing glucose and protein -> decrease oncotic pressure -> edema

Question 4

colloids fluids

Answer 4

-contain oncotic pressure
-albumin
-stay intravascular
-use for pts with renal failure (spilling proteins), liver disease, malnourished
-expensive
-can give this with a loop diuretic if there is volume overload -> pull fluid into the vessels with oncotic pressure and get rid of excess (DONT do this unless necessary)
-may need dialysis
-blood- increases the viscosity

-mannitol- decrease ICP

Question 5

pleural effusions

Answer 5

-lymphatic channels are overwhelmed
-volume overload

Question 6

D5W, D10W, D50W

Answer 6

-D5W
-sugar water
-glucose
-hypoglycemia
-brain injuries -> monitor glucose
-slows down metabolic state
-BAD CHOICE -> no electrolytes

-D10W
-someone in liver failure (cant make glucose)

-D50W
-glucose of 60

-keep glucose 180
-neurosurgical pts have glucose >180 -> 200 -> because they are AMS (hypoglycemia presents the same)

Question 7

normal saline (.9)

Answer 7

-higher osmolality than the body (135-145)
-this has 154
-eventually pt will become hypernatremic and acidotic (from Cl)
-hypertonic

Question 8

acidosis

Answer 8

-acidosis is better than alkaline-> hmg higher affinity for O2
-increase temp, increase CO2, increase 2,3 DPG
-left shift is BAD -> decrease affinity for O2

Question 9

.45% NaCl

Answer 9

-hypotonic
-take pts weight 70kg -> 110cc hours (add 40)
-give to pts that are mildly hyponatremic
-dehydrated

Question 10

lactated ringers

Answer 10

-Na is low
-Cl are okay
-has potassium
-trauma pts, burns, losing K
-treats metabolic acidosis

Question 11

plasmalyte

Answer 11

-same tonicity of fluid in body
-can be used safely
-expensive

Question 12

how to stop bleeding

Answer 12

-compression
-reboa catheter -> insert into femoral artery -> inflates to stop aortic bleeding

Question 13

transfusion

Answer 13

-hmg < 7 -> transfuse
-acute cardiac syndrome (ACS) - HAVING A MI, unstable angina, STEMI, NSTEMI -> hmg must be at least 8
-hypotensive pt no response to fluids, anemic -> attending tells you to transfuse -> give rational
-if you give cold blood -> temp drops -> qualitative platelet problems occur -> WARM the blood

-cryoprecipitate- fibrinogen
-platelets
-FFP
-give calcium too - pt will become hypocalcium

Question 14

DDAVP

Answer 14

-desmopressin
-increases the quality of platelets

Question 15

Erythropoiesis-Stimulating Agents (ESAs)

Answer 15

-interfere with fibrinolysis
-increase hypercoagulable state
-forms clots

Question 16

input vs output

Answer 16

-INPUT
-IV fluids
-colloids
-blood
-insensible gain

-OUTPUT
-urine
-drains
-insensible loss - breathing

Answer 17

colloids x 3 = crystaloids