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Principles of Anesthesia 1 (Summer 2023) > Exam 4 (Fluid therapy) > Flashcards

Exam 4 (Fluid therapy) Flashcards

1
Q

What are the parts (5) of the transcellular compartment?

A
  • GI tract
  • Urine
  • CSF
  • Joint fluid
  • Aqueous humor
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2
Q

What are the parts of the interstitial compartment?

A
  • Lymphatics & protein- poor fluid around cells
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3
Q

What is the speed solutes move at?

A

Proportional to distance squared

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4
Q

What is osmosis?

A
  • Semipermeable membrane separate pure water from water with solute
  • Diffuses from low to high concentration
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5
Q

What is osmotic pressure?

A

Pressure that resists the movement of water through osmosis

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6
Q

What is the formula for osmotic pressure?

A

P= (NRT) / V
- N= # of molecules
- R= constant
- T= temperature
- V= volume

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7
Q

What is osmolarity?

A

Number of active particles per Liter of solvent

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8
Q

What is osmolality?

A

Number of active particles per Kilogram of Solvent

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9
Q

What is the normal osmolality?

A

280 - 290 mosm

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10
Q

What does a higher osmolarity refer to?

A

Higher “Pulling power”

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11
Q

What makes up oncotic pressure?

A
  • Albumin
  • Globulins
  • Fibrinogen
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12
Q

Most of our daily average fluid output comes from?

A

Insensible loss (sweat, tears, breath vapor)

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13
Q

What does Aldosterone regulate?

A
  • Sodium & Potassium levels
  • If Na⁺ & fluid drops the aldosterone is released causing Na⁺ & H₂O retention
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14
Q

What do the hypothalamic osmoreceptors do?

A

Figure out osmolality vs osmolarity

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15
Q

What are the acute compensators (5) for volume loss?

A
  • venoconstriction
  • Mobilization of venous reservoir
  • Autotransfusion from ISF to plasma
  • Reduced urine production
  • Maintenance of cardiac output
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16
Q

What does Renin do/ where does it come from?

A
  • Cleaves Angiotensinogen to make Angiotensin 1
  • Released from Juxtaglomerular cells
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17
Q

How long does it take to restore an RBC count?

A

4 - 8 weeks

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18
Q

How long does it take the RAA Axis to restore volume?

A

12 - 72 hours

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19
Q

Aldosterone is released from the?

A

Adrenal cortex

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20
Q

Which IV fluids have the highest & lowest osmolarity?

A
  • Highest: Albumin
  • Lowest: D5
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21
Q

What is the most “balanced” crystalloid?

A

LR

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22
Q

What are the indications for crystalloids?

A
  • Replacement of free water & electrolytes
  • Volume expansion
23
Q

What is the distribution of volume of crystalloids over time?

A
  • After 20 mins 70% is intravascular
  • After 30 mins 50% is intravascular
24
Q

What are the possible side effects of crystalloids?

A
  • tissue edema
  • hypercoagulability
25
Q

What are downsides of normal saline?

A
  • Increases Cl⁻ & K⁺ concentrations
  • Late onset of diuresis
  • causes hyperchloremic metabolic acidosis
  • Increases AKI & RRT in critical care Pts
26
Q

What are the uses for 3% saline?

A
  • Treats hypoosmolar hyponatremia
  • Treats increased ICP
27
Q

Who should not receive LR?

A

Liver impaired Pts

28
Q

Which crystalloid excretes excess water faster? How?

A
  • LR > NS
  • Supresses ADH secretion
29
Q

Colloids do what to RBC’s?

A

Inhibit RBC aggregation

30
Q

How much hydroxyethyl starch is intravascular after 90 mins?

A

70 - 80%

31
Q

What are the side effects of hydroxyethyl starch?

A
  • Renal dysfunction
  • Coagulopathy (vWF, Factor VIII & clot strength)
32
Q

When is Dextran-40 use appropriate?
- How does it work?

A
  • For microvascular surgeries
  • Inhibits Factor VIII, vWF & Plt aggregation
33
Q

What does Dextran possibly interfere with?

A
  • Cross-matching due to it coating the RBC’s
34
Q

What are the signs of low intravascular volume?

A
  • tachycardia
  • Decreased pulse pressure
  • Hypotension
  • Decreased capillary refill
35
Q

How much volume must be lost to show S/S of volume depletion?

A

25%

36
Q

How do anesthetics relate to urine output?

A

Anesthetics release stress hormones, which leads to increased volume retention. Therefore decreased urine output

37
Q

What can excessive crystalloids or colloids lead to?

A
  • Edema (lungs, bowel, muscle
  • Increased capillary hydrostatic pressure
  • Reduced tissue oxygenation
  • poor wound healing
  • hypo/hyper coagulation
38
Q

What is the classic fluid therapy used for?

A
  • NPO deficit
  • Ongoing maintenance
  • Anticipated surgical loss
39
Q

What is the basic formula for NPO deficit?

A
  • 1st 10 Kg= 4 mL/kg/hr
  • 2nd 10 Kg= 2 mL/kg/hr
  • Each 1 Kg > 20 Kg= 1 mL/kg/hr
40
Q

How is a volume deficit replaced?

A
  • 1/2 of the volume in the 1st hour of Sx
  • 1/4 of the volume in the 2nd hour of Sx
  • 1/4 of the volume in the 3rd hour of Sx
41
Q

How much blood can a saturated lap sponge hold?

A

100mL

42
Q

How much blood can a raytech hold?

A

20mL

43
Q

How much blood does a saturated 4x4 hold?

A

10mL

44
Q

What is the traditional method of replacing preoperative bleeding?

A

3 : 1 with crystalloids

45
Q

A septic Pt with a 40 degree Celcius fever, has how much deficit?

A

30%

46
Q

A bowel Prep results in how much volume deficit?

A

~ 2,000 mL

47
Q

How are the evaporative/redistribution losses calculated?

A
  • Minimal: 0 - 2 mL/kg/hr
  • Moderate: 2 - 4 mL/kg/hr
  • Severe: 4 - 8 mL/kg/hr
48
Q

When is the Parkland formula used?

A

Only if 20% of TBSA has 2nd &/or 3rd degree burns

49
Q

What fluid is used in burns?
- At what rate?

A
  • LR
  • 4 mL/kg/% BSA burn (1/2 over first 8hrs & rest over 16hrs)
50
Q

What body surfaces count as 4.5%?

A
  • Each arm
  • Front of the head (face)
  • Rear of the head
51
Q

What does SPV measure/look at?

A

Lowest systolic peak vs highest systolic peak

52
Q

What does SVV look at?

A

Area under the curve

53
Q

What is a normal SVV?

A

10 - 15%

54
Q

What are the Limits to SVV monitoring?

A
  • Low HR/RR
  • Irregular heart beats
  • Mechanical ventilation w/ low Vt
  • Increased abdominal pressure
  • Thorax open
  • Spontaneous breathing

Principles of Anesthesia 1 (Summer 2023) (14 decks)

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