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Foundations > Fluid And Blood Therapy > Flashcards

Fluid And Blood Therapy Flashcards

1
Q

Total body water %

ICV %

ECV %

A

Water 60% of total body weight

40% intracellular tbw (2/3)

20% extracellular tbw (1/3)

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2
Q

Extracellular Volume Compartments:

A
  • Interstitial fluid volume (75% of ECV)

- Plasma volume (25% of ECV)

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3
Q

Total body water is ____ % of a man’s weight

A

55%

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4
Q

Total body water is ____ % of a woman’s weight.

A

45%

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5
Q

Total body water is ____ % of an infant’s weight.

A

80%

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6
Q

Obese individuals have ____ TBW per weight than non-obese individuals

A

Less

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7
Q

Intracellular Fluid has a high concentration of _______, _______, and _______.

A

Potassium (cation), Phosphate (anion), and Magnesium.

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8
Q

What maintains the > concentrations of K in ICF?

A

Na-K pump (active transport) ATPase

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9
Q

Na:K:ATP

A

3:2:1

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10
Q

Extracellular Fluid has high concentrations of ______ and ______.

A

Sodium (cation) and Chloride (anion).

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11
Q

What does Albumin in intravascular fluid (plasma) do?

A

Creates osmotic pressure to keep fluid in intravascular space.

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12
Q

__________ pressure tries to push fluids out of the intravascular space into interstitial space while _______ pressure pushes fluid from the interstitial space to the intravascular space.

A

Hydrostatic, Osmotic

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13
Q

__________ is an expression of the number of osmoles of a solute in a liter of solution.

A

Osmolarity

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14
Q

_________ is an expression of the number of osmoles of a solute in a kilogram of solvent.

A

Osmolality

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15
Q

Isotonic solutions are approximately _____ mOsm/L

A

285

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16
Q

Hypovolemia

A
  • Reduce circulating volume

- Loss of extracellular fluid

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17
Q

Dehydration

A
  • Concentration disorder

- Insufficient water present in relation to sodium levels.

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18
Q

_____ and _____ are responsible to normal osmotic activity of the ECF.

A

Sodium and chloride

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19
Q

Sodium (ECV and ICV levels)

A

ECV: 140 mEq/L
ICV: 25 mEq/L

(Maintained by Na-K-ATP pump)

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20
Q

BBB is or is not tightly packed with cells

A

Is

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21
Q

Does Na cross the BBB?

A

No

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22
Q

What is the most common electrolyte abnormality in hospitalized patients.

A

Na (Hyponatremia)

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23
Q

Biggest risk for Hyponatremia?

A

Cerebral edema

Slide 27 other manifestations of < Na

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24
Q

Tx of Hyponatremia

A
  • Fluid restriction

- hypertonic saline and diuretic (osmotic or loop)

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25
Q

Correction of serum sodium levels too fast can cause …

A

Neurological damage and myelinolysis

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26
Q

How fast to correct hyponatremia?

A

1-2 mEq/L/Hour

Don’t correct Na fast

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27
Q

The most common causes of hypernatremia:

A
  • Water deficiency r/t
    1. Excessive loss
    2. Inadequate intake

others:
Diabetes, Renal dysfunction…

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28
Q

Most worrisome manifestations of hypernatremia?

A

Intarcranial bleeding
>Na shrinks brain, rippling of vessels.

Slide 32 other manifestations of >Na

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29
Q

How to correct hypernatremia?

A
  • replace the water deficit.
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30
Q

How fast to correct > Na

A

Slowly (over 24 hours time frame)

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31
Q

Potassium is largely responsible for…

A

Resting membrane potential

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32
Q

Potassium is balanced by ___ absorption and _____ excretion.

A

GI, renal

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33
Q

What is the most common electrolyte abnormality in the clinical practice?

A

Hypokalemia

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34
Q

Hypokalemia occurs x2 more in ____ than in _______.

A

Men, women.

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35
Q

< K Causes SLIDE 35

A

SLIDE 35

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36
Q

< K cardiac manifestations: (4)

A

ST-segment depression
U wave (3.0)
Flat or inverted T waves
Ventricular ectopy

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37
Q

< K Neuromuscular manifestations: (3)

A

Weakness
Decreased reflexes
Confusion

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38
Q

Hyper or hypo ventilate pts with < K

A

Hypo (avoid hyper)

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39
Q

Cardiac manifestations of >K

A 
Tall, T waves
Widened QRS complex
Prolonged PR interval
Flattened or absent P wave
ST segment depression
Cardiac arrest
V-Fib, Tachy, ST depression, 1 degree AV Block
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40
Q

To of >K

A

IV Calcium first, Insulin and Glucose,

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41
Q

Upper limit of K for elective procedures:

A

5.5

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42
Q

___ - ___ % of Mg is stored in bone, ___% in cells, and ___% in serum

A

40-60%, 30%, 1%

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43
Q

Where is Mg regulated in the body?

A

Intestines and Kidney

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44
Q

Normal limits of Mg

A

1.7-2.5

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45
Q

Cardiac manifestations of < Mg

A 
Flat T waves
U waves
> QT interval
Widened QRS
Atrial and Ventricular PVCs
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46
Q

Tx of < Mg

A

IV Mg sulfate 1-2 g over 5 mins.

Followed by continuous IV 1-2 g/hr.

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47
Q 
Clinical Manifestations of > Mg
3-5
4-7
5-10
7-10
10
10-15
15-20
A

3-5: Flushing, N/V
4-7: Drowsiness, < DTR, Weakness
5-10: < BP, <hr>

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48
Q

Tx of > Mg

A

Use Ca as antagonist in urgent situations:

  • Bradycardia
  • HB
  • Respiratory depression
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49
Q

> Mg _____ ND NMB

A

Potentiates (lasts longer)

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50
Q

Tx of > Ca

A

NSS

Loop Diuretics ~ renal excretion of Ca

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51
Q

Cardiovascular manifestations of > Ca

A

HTN
HB
< QT interval
Dysrhythmias

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52
Q

Neuromuscular manifestations of >Ca

A

Muscle weakness
< deep tendon reflexes
Sedation

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53
Q

> Ca is 50% caused by _________.

A

Hyperparathyroidism

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54
Q

Tx of < Ca

A 
Calcium Chloride (rapid)
Calcium Gluconate (slower)
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55
Q

Cardiac manifestations of < Ca

A 
Dysrhythmias 
> QT interval
T-wave inversion
Hypotension 
< myocardial contractility
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56
Q

Pulmonary manifestations of Ca

A

Laryngospasm
Bronchospasm
Hypoventilation

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57
Q

Manifestations of < Ca

A 
(Neuromuscular irritability)
Cramps
Weakness
Chvostek sign
Trousseau sign
Seizure
Numbness
Tingling
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58
Q

Ca functions

A

Second messenger that couples cell membrane receptors to cellular responses.

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59
Q

3 Historical Intra-Operative Fluid Loss

A

Insensible Loss
Third Spacing Loss
Blood Loss

60
Q

Insensible loss (Historical)

A

Water loss through

  • Urine
  • Feces
  • Sweat
  • Respiratory Tract
61
Q

Correct Insensible loss with _________ at a rate of…

A

Crystalloid at 2mls/Kg/hr

62
Q

Historical 3rd Space Loss

A
  • Fluid from intravascular to interstitial space

- Bigger incision (and where) > 3rd space loss

63
Q

Historical 3rd space loss replacement for min, mod, and severe trauma.

A

Min: 3-4 mL/Kg
Mod: 5-6 mL/Kg
Severe: 7-8 mL/Kg

64
Q

How long does it take for 3rd space loss to become mobilized?

A

3 days.

> intravascular volume on the 3rd day. Worry about CHF patients.

65
Q

Goals of NEW perioperative Goal-Directed Therapy (PGDT)

A

Minimize O2 demand and Optimize CO…

66
Q

NEW PGDT hemodynamic monitoring…

A

-Frank-Starling (LVEDV) (> preload >contractility)

  • Dilution Techniques (PA-Cath)
  • Pulse Contour (minimally or noninvasive)
  • Esophageal Doppler & Echo
  • Measures of Tissue O2
67
Q

New PGDT Protocals:

A
  • Baseline target hemodynamic measures.
  • Small fluid bolus to assess Frank-Starling curve
  • Maintain end-points with fluids
68
Q

ERAS

NAGELHOUT pg 358-359

A

*Look it up

69
Q

Crystalloids cross plasma membranes?

A

Yes

70
Q

Crystalloids > risk of…

A

Pulmonary Edema with large volumes

71
Q

Historical Crystalloid replacement with blood loss…

Crystalloid:Blood

A

3:1

72
Q

T:F not not give Glucose containing solutions except to prevent hypoglycemia in diabetic patients.

A

True

73
Q

Good chart for Crystalloid vs Colloids

Slide 74

A

Slide 74

74
Q

Colloids (4)

A

Albumin
Plasmanate
Hetastarch
Dextran

75
Q

Do Colloids easily cross plasma membrane?

A

No

They remain in the intravascular space
No evidence that colloids are better than crystalloids

76
Q

Blood loss replacement with colloids:

A

1:1

77
Q

Colloids Advantages (1) Disadvantages (3)

A

< disease transmission

Lack of O2 carrying capacity
Lack of coat factors
> Cost

78
Q

Hetastarch

A

> volumes can cause dilutional coagulopathy.

Can < factor VII with > Volumes (>1000)

79
Q

FDA in 2015 concluded that…

A

> mortality and RRT in critically ill pts, especially with sepsis tx with Hetastarch. Stopped using it.

80
Q

Dextran

A

> Volumes can cause dilution coagulopathy.

< platelet adhesiveness

Potential anaphylactic reactions

Interferes with ability to cross match secondary to agglutination of RBCs

81
Q

5% Albumin

A

Used for rapid expansion of intravascular fluid volume.

82
Q

25% Albumin

A

Hypoalbuminemia.

83
Q

S/S of intraoperative blood loss:

A

> HR
< BP
< CVP
< mixed venous O2

84
Q

Oliguria

A

<0.5 mL/Kg/hr

Urine output of 0.5-1 mL/Kg/hr is
Indicative of adequate intravascular volume.

Diuretics affect intraoperative fluid volume measurement.

85
Q

Pulse Paradox > than ___ may indicate hypovolemia.

A

10 mmHg

8-10 normal

86
Q

Young healthy individuals may lose ___% of circulating BV without demonstrating clinical signs.

A

20%

87
Q

Physiologic response to acute blood loss.

A

-Vasoconstriction (BL of 10% can mask) (Anesthesia also)

88
Q

Indication for blood Transfusion:

A

Hgb < 6g/dL

Rarely justified if Hgv > 10

89
Q

Acute blood loss should be tx with _____.

A

Blood

too much crystalloids will dilute RBCs

90
Q

Crossmatch:

A

Incubating (45mins) recipient’s plasma with donors RBCs

91
Q

Emergency transfusions: Universal Donor:

A

O negative.

Avoid problems by giving pt’s typed blood ASAP.

92
Q

Type Specific Blood:

A

Blood that has only been typed for the A, B, and Rh antigens.

First Phase of cross match process

(5 mins to perform)

1:1000 chance of reaction

93
Q

Typed and Screen:

A

Blood is screened for most common antibodies after type specific blood

1:10,000 risk of reaction

94
Q

When to order Type and Match vs Type and Screen:

A

Type and Match if > potential for blood match.

Type and Screen if < potential for blood loss.

95
Q

How long can blood be stored for?

A

21-35 days at 1-6*C.

96
Q

1 U of Whole Blood = ____ mls and Hct ___%.

A

450mls. (65 mls of that is citrate preservative) and 40%.

97
Q

1 U of Packed RBCs = ___mls and Hct __%

A

300mL and 70%.

98
Q

Packed RBCs are indicated for…

A

Anemia not associated with hemorrhage or shock.

99
Q

Hgb concentrations will > by __ per unit PRBC in a 70Kg adult.

A

1g/dL

100
Q

Reconstitution of PRBCs in ____ may result in _____.

A

Calcium, clotting.

101
Q

Advantages of PRBCs vs whole blood

A

< citrate toxicity with PRBCs

< allergic reaction

102
Q

Platelet administration is indicated intraoperatively when platelet count in < _______ cells/mm3

A

50,000.

103
Q

Platelet count will > by ______ to _______ with each unit of platelets.

A

5,000 to 10,000 cells/mm3

104
Q

Platelet Risks

A

Viral disease transmission

Bacterial infections

105
Q

Bacterial risk infections with platelets

A

1 : 12,000

106
Q

Fresh Frozen Plasma:

A

Contains all plasma proteins, all coats except platelets, factor V and VII

107
Q

FFP is given when…

A

> PT and PTT more than 1.5 x normal.
Reversal of Warfarin therapy
To correct known factor deficiencies.

108
Q

FFP risks:

A

Transmission of viral diseases

Allergic reactions

109
Q

Cryoprecipitate contains high concentrations of …

A

Factor VIII, XIII,
Von Willebrand factor
Fibrinogen, Fibronectin

110
Q

(9) Complications of blood therapy

A 
Transfusion reactions
Metabolic abnormalities
Citrate intoxication
Transmission of viral diseases
Microaggregates
Hypothermia
Coagulation disorders
Acute Lung Injury
Immunosuppression
111
Q

Most frequent transfusion reaction:

A

Febrile

112
Q

Tx of Febrile Transfusion reaction:

A

< rate of infusion, antipyretics

Can continue to give product

113
Q

Allergic Transfusion reaction manifestations:

A

Urticaria
Pruritus
Occasional facial swelling

114
Q

Allergic TR occurs due to…

A

Presence of incompatible plasma proteins in donor blood.

115
Q

Allergic TR Tx

A

IV Antihistamines, Benadryl, stop transfusion.

116
Q

Hemolytic TR

Result in

A

Occurs with erroneous unit of blood to patient.

Results in renal failure and DIC.

117
Q

Test to confirm Hemolytic Reaction

A

Direct antiglobulin test
Bilirubin will peak 3-6 hours after start of transfusion.

(Hemoglobinuria or hemolysis is to be tx as hemolytic until proven otherwise.)

118
Q

Tx of Hemolytic reaction

A
  • Stop transfusion!!
  • Renal failure (maintain urine output 100mL/hr with LR, mannitol, furosemide)
  • Bicarbonate to alkalinity urine
119
Q

5 Metabolic BT abnormalities:

A 
> H+
>K
< 2,3-DPG
Metabolic alkalosis (compensation)
Hypocalcemia
120
Q

Does pt blood pH > or < after BT?

A

>

121
Q

Does K > or < with BT

A

No change

122
Q

Does 2, 3 DPG > or < with storage of blood broducts.

A
123
Q

< 2, 3 DPG left or right shift

A

Left

> affinity of Hgb for O2.

124
Q

Infusion of citrate preservative can result in ________

A

Hypocalcemia

125
Q

HIV chances

A

1:1,000,000

126
Q

Hepatitis virus chances

A

1:60,000

127
Q

Use _______ out of concern of ___________.

A

Filters, microaggregates

128
Q

Cold patients can have _________ irritability, ___ O2 demand.

A

Cardiac, >

129
Q

DIC: ___ Platelets, __ PT, __ PTT, __ fibrinogen, __ fibrin split products.

A 
Decrease
Increase
Increase
Decrease
Increase
130
Q

Tx of DIC

A

Platelets and FFP.

131
Q

TRALI occurs in ____ of transfusion

A

6 hours

132
Q

Immunosuppression is a concern for those with __________.

A

Malignancy

133
Q

Do not give Intraoperative salvage in pts with…

A

Malignancy
Blood-born disease
Blood contaminated with bowel contents.

134
Q

Cell saver blood is __-__% Hct and pH is _______.

A

50-60%, alkaline

135
Q

It is contraindicated in pts for hemodilution who are…

A

Anemia
Sever cardiac disease
Sever neurological disease

136
Q

Hemodilution is a ________ type of transfusion

A

Autologous

137
Q

Strongly recommended transfusion thresholds:

A

Hgb <7 in pts w/ cv or Pulm disease and > 65 age
Hgb <6 in pts undergoing CABG
> 30% loss of blood volume 1,500 ml cumulative losses
Platelet count < 50,000
FFP: INR > 2.0, PT AND PTT > 1.5 norm
Cryo: fibrinogen < 80-100

138
Q

FFP:Platelets:PRBCs

A

1:1:1

139
Q

Calculations

SLIDE 160 - 163 *****

A

SLIDE 160*****

140
Q

EBV Calculations:

Premi:
Term:
12 months:
Adult male:
Adult female:
Obese:
A 
Premi: 95-100 ml/kg
Term: 85-90 ml/kg
12 months: 80 ml/kg
Adult Male: 70-75 ml/kg
Adult female: 65-70 ml/kg
Obese: 55 ml/kg
141
Q

ABL =

A

[EBV X (Hct - target Hct)] / Hct

142
Q

Fluid Calculations: Maint

A

4:2:1

1st 10 kg = 4 ml/kg/hr
Then 2nd 10kg = 2 ml/kg/hr
>20kg = 1 ml/kg/hr

= # per hour

143
Q

Fluid Deficit =

A

Maint # x hours of NPO

Pt don’t drink much fluids in the middle of the night…they sure in the afternoon

144
Q

How to split Deficit?

A

(Over 3 hours)
1/2 of maintenance X hours NPO for 1st hour
1/4 “ “ for 2nd hour
1/4 “ “ for 3rd hour

145
Q

TRALI occurs most frequently when which two blood products are given?

A

FFP, Platelets

146
Q

Bacterial contamination occurs at the greatest rate with what blood product?

A

Platelets

Foundations (5 decks)

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