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NUNA 692 Principles III > Exam IV: Peds Intraop Fluid Mngmnt > Flashcards

Exam IV: Peds Intraop Fluid Mngmnt Flashcards

1
Q

Children have small size, large surface area to _____ratio and immature ______ mechanisms.

A

volume
homeostasis

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2
Q

Hypo- and hyper______, hypo- and hyper_____ are common.

A

natremia
kalemia

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3
Q

Children overload _____ and dehydrate ____.

A

easily
easily

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4
Q

Large amounts of IV fluids should be _____.

A

warmed

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5
Q

____ should continue perioperatively.

A

TPN

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6
Q

Use volumetric chambers, micro-drips and/or pumps for children ____ years old

A

<10

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7
Q

Intraop

Give maintenance _____ to patients on preop TPN or high glucose solutions.
Use ___-____ _____ (LR, NS, plasmalyte) for maintenance and 3rd space losses.
Use NS* or plasmalyte to mix with ____ _____.

A

glucose
non-glucose crystalloid
transfused PRBCs

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8
Q

Intraop

“Old” PRBCs have higher ____. Beware of potentially lethal hyper_____ for massive transfusion (>1 blood volume).

A

K+
hyperkalemia

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9
Q

Massive transfusion leads to hypo______ (citrate binds ____)

A

hypocalcemia
Ca++

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10
Q

Use _____ for dilutional thrombocytopenia or documented decreased platelet count.

A

platelets

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11
Q

Use ____ for dilutional coagulopathy or surgical “oozing”.

A

FFP

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12
Q

_____: Albumin, hetastarch, blood products

A

Colloids

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13
Q

Consider autologous donation, directed donors, cell saver, deliberate hypotension, or normovolemic hemodilution for ____ ____ ____ procedures.

A

high blood loss

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14
Q

____ _____ a low Hct in healthy, hemodynamically stable patients, especially if blood losing is over.

A

“Ride out”

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15
Q

Hypernatremia
Acute: ____, ____, _____
Treatment: ____ or ____ ____ with slow correction of Na+

A

Irritability, coma, seizures
Colloid or NS bolus

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16
Q

Hyponatremia
Acute: Headache, nausea, weakness, confusion, irritability, seizures
Advanced: _____ arrest, _____ _____ injury
Treatment: ____ correction for asymptomatic case
Acute: _____ correction

A

Respiratory arrest, irreversible neurologic injury
Slow
Rapid

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17
Q

Hyperkalemia
Acute: Renal insufficiency, massive tissue trauma, acidosis, sux with myopathies, burns, motor neuron disease, sepsis, massive transfusion, MH
_____ T waves, PR _____, QRS _____, eventual sinusoidal
Treatment:

A

Peaked
lengthening
widening
IV Ca++, bicarbonate for acidosis, glucose/insulin

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18
Q

Hypokalemia
Acute: Vomiting, diarrhea
Muscle weakness, _____ QT, _____ T waves, ___ waves
Treatment: Oral supplements if possible or ____ ____ correction

A

prolonged
dampened
U
slow IV

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19
Q

Intraoperative fluids lost by (4)

A
  • Surgical blood loss
  • Surgical trauma/capillary leaking leading to protein movement into the interstitial space (3rd space loss)
  • Anesthesia causes vasodilation which causes relative hypovolemia
  • Direct evaporation
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20
Q

Replace blood loss __:__ with blood products or colloids OR __:___ with isotonic crystalloid*

A

1:1
1:1.5 – 3

*numbers vary for ratio of blood loss to crystalloid

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21
Q

HYPERCHLOREMIC ACIDOSIS

large amounts of NS cause excess _____ which leads to acidosis

A

Cl-

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22
Q

HYPERCHLOREMIC ACIDOSIS

acidosis does not occur with equivalent amounts of ___

A

LR

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23
Q

HYPERCHLOREMIC ACIDOSIS

LR is _____ with blood products

A

incompatible
(Ca++ binds to citrate which leads to emboli)

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24
Q

HYPERCHLOREMIC ACIDOSIS

Consider _____ to NS when transfusing (Ex: plasmalyte, normosol).

A

alternative

25
Q

Massive Blood Transfusion (MBT) in Children

Defined: Replacement of one or more blood volumes (BV) - or >___mL/kg in <___ hours

A

30
4

26
Q

Massive Blood Transfusion (MBT) in Children

____ until crossmatched (O+ can be used in males???)

A

O-

27
Q

Massive Blood Transfusion (MBT) in Children

Damage control approaches ___ ____ ____ in children.

A

not fully studied

28
Q

Massive Blood Transfusion (MBT) in Children

MBT-induced coagulopathy usually d/t _____.
Other causes: _____, ____
Fixed ratio (1:1:1) not fully researched in children.

A

dilution
Fibrinolysis, DIC

29
Q

Massive Blood Transfusion (MBT) in Children

___-____ BVs lost causes significant thrombocytopenia which leads to bleeding
Consider platelet (plt) transfusion after ___-___ BVs.
Plt needs dependent on starting plt count & function.

A

2 – 2.5
1 – 1.5

30
Q

Massive Blood Transfusion (MBT) in Children

Replacement of 1 – 1.5 BVs with PRBCs and fluids leads to ___% loss of clotting factors
Consider FFP after __ BV
Author recommendation: Give FFP after 1 BV loss then 1 FFP : 2 PRBCs
Check coags after ____ ____ loss.

A

70
1
every BV

31
Q

Massive Blood Transfusion (MBT) in Children

FDA approved factor VII (Novo 7): Hemophilia, congenital factor VII deficiency
Caution in children when using off-label (surgery or trauma induced bleeding) and ONLY for ___-____ _____

A

life-threatening bleeding.

32
Q

Massive Blood Transfusion (MBT) in Children

In the lit: Early use of ____ in children supported

A

TXA

33
Q

Massive Blood Transfusion (MBT) in Children

____: Suspect with ongoing bleeding if pre-op coags and plt ct were WNL.
Treat the ____ (shock, acidosis, sepsis)

A

DIC
cause

34
Q

MBT in children

Hyperkalemia: Risk increases with increased PRBC ____ ____ and _____

A

shelf time and irradiation.

35
Q

MBT - hyperkalemia

Usually ___ _____ with slow rate through peripheral IV.

A

not problematic

36
Q

MBT - hyperkalemia

120ml/min/70 kg = ___mL/kg/min/small child

A

2

37
Q

MBT - hyperkalemia

Hyperkalemia during MBT usually d/t:

A

tissue injury, rapid transfusion, acidosis (poor perfusion), hypothermia, hypocalcemia.

38
Q

MBT - hyperkalemia

Hyperkalemic EKG: _____ dysrhythmia and ____ T waves (p. 213)

A

Ventricular
peaked

39
Q

MBT - hyperkalemia

Treatment:

A

Ca++, hyperventilation, bicarb, albuterol, glucose/insulin (p. 214)

40
Q

MBT - hyperkalemia

Author recommendation: Anticipate blood loss, transfuse early, PIV if possible, use warming devices and minimize use of “old” blood, especially if irradiated.
Dilemma: _____________________

A

Small bore PIV vs large bore CVL

41
Q

MBT:

Hypocalcemia and/or citrate toxicity EKG: Widened QRS, prolonged QT, peaked T waves
Hypocalcemia and hyperkalemia treated with _____.

A

Ca++

42
Q

MBT:

Treat documented ____ with bicarb.

A

acidosis

43
Q

MBT:

Prevent/treat _____ aggressively.

A

hypothermia

44
Q

MBT:

TEG and ROTEM (_____ therapy) growing in popularity

A

targeted!!!!

45
Q

MBT:

lethal triad

A

hypothermia
coagulopathy
acidosis

46
Q

Maintenance IV Fluid Requirements(_______- Rule)

A

4-2-1

47
Q

weight: < 10 kg needs ___ ml/kg/hr

A

4

48
Q

weight: 10-20 kg needs ___+___ mL/kg for each kg > ____

A

40 + 2
10

49
Q

weight > 20 kg needs ___+___ mL/kg for each kg > ____

A

60+1
20

50
Q

How many hours has the child been NPO?
What is the child’s hourly maintenance rate?

Deficit equation is ________________

A

Deficit = maintenance rate x hours NPO

51
Q

Third Space Losses*

level mild (insensible, small incision, scopes) = __-__ mL/kg/hr

A

3-4

52
Q

Third Space Losses*

level mod (ortho, large incision) = __-__ mL/kg/hr

A

5-7

53
Q

Third Space Losses*

level extensive (open, abdominal, spinal) = ____ mL/kg/hr

A

> 10

54
Q

Maximum Allowable Blood Loss

Calculate child’s ____ ____ _____ (EBV)

A

estimated blood volume

55
Q

Maximum Allowable Blood Loss

Choose transfusion trigger (frequently Hct of ___ used)

A

25

56
Q

Maximum Allowable Blood Loss

10-15 mL/kg PRBCs causes Hgb increase by __-___ g/dL

A

2-3

57
Q

MABL =

A

(EBV x (starting Hct - trigger Hct)) / starting Hct

58
Q

Replace ½ of fluid deficit during ____ hour ¼ during ____ hour ¼ during ____ hour
Maintenance + 3rd space + deficit = mL/Hour
Do not exceed ___ mL/kg/hour (unless replacing blood loss).
EBL must be replaced in addition to above.
Roll “left-over” to next hour.

A

1st
2nd
3rd
20

NUNA 692 Principles III (20 decks)

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