Fluid And Blood Flashcards
What respiratory acidosis does to cv system, tx
Dec myo contractility, inc PVR, dec SVR. Vent, bicarb, improve pulm func
Respiratory alkalosis: d/t what, results in what, tx
Inc minute vent from pain/anxiety/hypoxemia/cns disease/sepsis. Tx cause. Hypokalemia, hypocalcemia, dysrhythmias, bronchoconstriction, hypotension
Metab acidosis: due to what, results in what, tc
Uremia, ketoacidosis, lactic acidosis, diarrhea, renal fail, saline admin. Results in reduced myo contractility, inc PVR, dec SVR. IV fluid and na hco3
Metab alkalosis: d/t what
Diuretics, renal hypoperfusion, hypokalemia, hypochloremia, hypovolemia.
Metab alkalosis results in what
Leads to hypokalemia/hypocalcemia/arrhythmias/hypoventilation/hypercarbia.
Metabolic alkalosis tx
Expand IV volume, admin K, Carbonic anhydrase inhibitor
Body fluid: % weight tbw, intracellular, extracellular
60%, 40%,
20% (plasma 4% isf 16%)
Main determinant of extracellular osmotic p, intracellular osmotic p
Na, k
Physical signs for assessing fluid vol
Turgor, MM, edema, lung sounds, VS, UOP, HCT, urine specific gravity, BUN/creat
Maintenance fluid calc
4 cc/kg/hr for 1st 10kg. 2cc for 2nd 10 kg. 1 cc for each kg after that
Fluid deficit
Maintenance req x hrs NPO.
Fluid should be used to replace what beyond NPO deficit
MAP, HR, filling pressures prior to induction. Also to maintain UOP
Fluid deficit replacement timing in or
1/2 first hr. 1/4 2nd and 3rd hrs
Other sources of fluid loss in OR
GI prep, NGT drainage, vomit, diarrhea, fever
Visual estimation of blood loss
Floor, surgical drapes, soaked gauze (4x4=10cc), laparotomy pad (100-150cc), suction container
EBV: premies, term neonate, infants
- 80
EBV: kids, men, women
- 65
ABL calc
EBV (starting hct- allowable hct) / starting hct
3rd space loss due to what
Trauma, sepsis, burns, ascites
Replacement for evaporative loss in minimal cases, moderate, severe, and emergency. And cases under each category
Min (eye, lap Chloe, hernia, knee scope) 0-2 ml/kg/hr. Mod (open Chloe, appendec) 3-5, severe (bowel sx, thr) 6-9, emergency (gun shot, MVA) 10-15
What eras goal directed fluid tx about
Avoidance of na and h20 overload. Questions 3rd space loss. Monitoring of hr, bp, peripheral perfusion and temp, UOP, CVP and markers like lactate
Goal directed fluid therapy uses what to estimate volume
Stroke volume variation, pulse pressure variation, systolic pressure variation
Hypotonic solutions
- D5W. Water loss
Isotonic solutions
- Replaces water and lyte loss. Replacement fluids, LR and NS
Hypertonic solutions
Hyponatremia and shock. D5 1/2 NS (432), 3% NS (1026)
LR has what in it
NaCl w K and Ca and lactate buffer. Isotonic (275), 100 cc free water per L. Lowers Na. Lactate converted to HCO3. Most similar to ECF. Avoid in ESRD
Normal saline tonicity, can do what. Use
Isotonic 308. In large volumes produces high cl content, dilutional hyperchloremic acidosis. Preferred for diluting RBCs
Normal saline compared to plasma
More na and cl. No k. Doesnt have glucose
Normosol r compared to plasma
More like plasma than na cl, similar to LR except has mg, acetate, and gluconate. Still isotonic
D5w tonicity, causes what
Hypotonic 260. Free water intoxication and hyponatremia. Provides calories. Can cause hyperglycemia unless dm receiving insulin therapy or neonate
Hypertonic solutions use. Risk of what
Low volume resuscitation. Tx hyponatremia. Risk of hyperchloremia, hypernatremia, and cellular dehydration
Dextran. Type of solution. What 70 vs 40 used for
Colloid, glucose polymers, degraded to glucose. 70- vol expansion. 40- prevents thrombosis
Dextran SE
Anaphylactoid, plt inhibition, non cv pulm edema, interferes w crossmatching
Hetastarch. Use, risks, limit
Not as effective as albumin for vol expansion. Nonantigenic and less expensive. Really excreted. Coagulopathy d/t dilutional thrombocytopenia. <20 ml/kg/day
Why crystalloids > colloids
As effective in restoring volume if giving enough. Supports UOP better. Less likely to cause pulm edema, coagulation and antigenic issues. Less expensive
Colloid > crystalloid reasons
Restore iv volume better, better oncotic p. 1/2 life 3-6 hrs vs 20-30 mins. Better in hypoproteinemia. Less tissue edema
Clinical judgement factors for blood replacement
Hgb and hct, cv status, age, ant blood loss, arterial oxygenation, CO and blood volume
Complications of autologous blood transfusion
Anemia, pre op myo ischemia from anemia, admin of wrong unit, need for more freq blood transfusion, febrile/allergic rxn
Plt: uses, volume. How it inc ct. risks
Low or dysfunctional plt, active bleed, plt <50k. 200-400 mls. One u inc plt ct 7-10k 1 hr after transfusion. Plt related sepsis or bacterial contamination
FFP: what it has, volume, needs to be what
Clotting factors and plasma proteins (no plt). 200-250 mls. ABO compatible
FFP uses
Warfarin reversal. Coag factor deficiencies. Correcting microvascular bleeding in inc PT/PTT. Corrects bleed in pt w >1 blood vol replacement when pt/ptt cant be obtained quickly
Cryo: contains what. Tx what. Rate
Factor 8, fibrinogen, vwf, factor 13. Tx VWF disease, fibrinogen deficiencies in blood loss. ABO compatible. 200 ml/hr, done in 6 hrs