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Anesthesia Basics > Fluid And Blood > Flashcards

Fluid And Blood Flashcards

1
Q

What respiratory acidosis does to cv system, tx

A

Dec myo contractility, inc PVR, dec SVR. Vent, bicarb, improve pulm func

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2
Q

Respiratory alkalosis: d/t what, results in what, tx

A

Inc minute vent from pain/anxiety/hypoxemia/cns disease/sepsis. Tx cause. Hypokalemia, hypocalcemia, dysrhythmias, bronchoconstriction, hypotension

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3
Q

Metab acidosis: due to what, results in what, tc

A

Uremia, ketoacidosis, lactic acidosis, diarrhea, renal fail, saline admin. Results in reduced myo contractility, inc PVR, dec SVR. IV fluid and na hco3

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4
Q

Metab alkalosis: d/t what

A

Diuretics, renal hypoperfusion, hypokalemia, hypochloremia, hypovolemia.

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5
Q

Metab alkalosis results in what

A

Leads to hypokalemia/hypocalcemia/arrhythmias/hypoventilation/hypercarbia.

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6
Q

Metabolic alkalosis tx

A

Expand IV volume, admin K, Carbonic anhydrase inhibitor

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7
Q

Body fluid: % weight tbw, intracellular, extracellular

A

60%, 40%,

20% (plasma 4% isf 16%)

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8
Q

Main determinant of extracellular osmotic p, intracellular osmotic p

A

Na, k

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9
Q

Physical signs for assessing fluid vol

A

Turgor, MM, edema, lung sounds, VS, UOP, HCT, urine specific gravity, BUN/creat

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10
Q

Maintenance fluid calc

A

4 cc/kg/hr for 1st 10kg. 2cc for 2nd 10 kg. 1 cc for each kg after that

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11
Q

Fluid deficit

A

Maintenance req x hrs NPO.

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12
Q

Fluid should be used to replace what beyond NPO deficit

A

MAP, HR, filling pressures prior to induction. Also to maintain UOP

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13
Q

Fluid deficit replacement timing in or

A

1/2 first hr. 1/4 2nd and 3rd hrs

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14
Q

Other sources of fluid loss in OR

A

GI prep, NGT drainage, vomit, diarrhea, fever

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15
Q

Visual estimation of blood loss

A

Floor, surgical drapes, soaked gauze (4x4=10cc), laparotomy pad (100-150cc), suction container

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16
Q

EBV: premies, term neonate, infants

A
    1. 80
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17
Q

EBV: kids, men, women

A
    1. 65
18
Q

ABL calc

A

EBV (starting hct- allowable hct) / starting hct

19
Q

3rd space loss due to what

A

Trauma, sepsis, burns, ascites

20
Q

Replacement for evaporative loss in minimal cases, moderate, severe, and emergency. And cases under each category

A

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

21
Q

What eras goal directed fluid tx about

A

Avoidance of na and h20 overload. Questions 3rd space loss. Monitoring of hr, bp, peripheral perfusion and temp, UOP, CVP and markers like lactate

22
Q

Goal directed fluid therapy uses what to estimate volume

A

Stroke volume variation, pulse pressure variation, systolic pressure variation

23
Q

Hypotonic solutions

A
  1. D5W. Water loss
24
Q

Isotonic solutions

A
  1. Replaces water and lyte loss. Replacement fluids, LR and NS
25
Q

Hypertonic solutions

A

Hyponatremia and shock. D5 1/2 NS (432), 3% NS (1026)

26
Q

LR has what in it

A

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

27
Q

Normal saline tonicity, can do what. Use

A

Isotonic 308. In large volumes produces high cl content, dilutional hyperchloremic acidosis. Preferred for diluting RBCs

28
Q

Normal saline compared to plasma

A

More na and cl. No k. Doesnt have glucose

29
Q

Normosol r compared to plasma

A

More like plasma than na cl, similar to LR except has mg, acetate, and gluconate. Still isotonic

30
Q

D5w tonicity, causes what

A

Hypotonic 260. Free water intoxication and hyponatremia. Provides calories. Can cause hyperglycemia unless dm receiving insulin therapy or neonate

31
Q

Hypertonic solutions use. Risk of what

A

Low volume resuscitation. Tx hyponatremia. Risk of hyperchloremia, hypernatremia, and cellular dehydration

32
Q

Dextran. Type of solution. What 70 vs 40 used for

A

Colloid, glucose polymers, degraded to glucose. 70- vol expansion. 40- prevents thrombosis

33
Q

Dextran SE

A

Anaphylactoid, plt inhibition, non cv pulm edema, interferes w crossmatching

34
Q

Hetastarch. Use, risks, limit

A

Not as effective as albumin for vol expansion. Nonantigenic and less expensive. Really excreted. Coagulopathy d/t dilutional thrombocytopenia. <20 ml/kg/day

35
Q

Why crystalloids > colloids

A

As effective in restoring volume if giving enough. Supports UOP better. Less likely to cause pulm edema, coagulation and antigenic issues. Less expensive

36
Q

Colloid > crystalloid reasons

A

Restore iv volume better, better oncotic p. 1/2 life 3-6 hrs vs 20-30 mins. Better in hypoproteinemia. Less tissue edema

37
Q

Clinical judgement factors for blood replacement

A

Hgb and hct, cv status, age, ant blood loss, arterial oxygenation, CO and blood volume

38
Q

Complications of autologous blood transfusion

A

Anemia, pre op myo ischemia from anemia, admin of wrong unit, need for more freq blood transfusion, febrile/allergic rxn

39
Q

Plt: uses, volume. How it inc ct. risks

A

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

40
Q

FFP: what it has, volume, needs to be what

A

Clotting factors and plasma proteins (no plt). 200-250 mls. ABO compatible

41
Q

FFP uses

A

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

42
Q

Cryo: contains what. Tx what. Rate

A

Factor 8, fibrinogen, vwf, factor 13. Tx VWF disease, fibrinogen deficiencies in blood loss. ABO compatible. 200 ml/hr, done in 6 hrs

Anesthesia Basics (10 decks)

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