Fluid And Blood Therapy Flashcards
(146 cards)
1
Q
Total body water %
ICV %
ECV %
A
Water 60% of total body weight
40% intracellular tbw (2/3)
20% extracellular tbw (1/3)
2
Q
Extracellular Volume Compartments:
A
- Interstitial fluid volume (75% of ECV)
- Plasma volume (25% of ECV)
3
Q
Total body water is ____ % of a man’s weight
A
55%
4
Q
Total body water is ____ % of a woman’s weight.
A
45%
5
Q
Total body water is ____ % of an infant’s weight.
A
80%
6
Q
Obese individuals have ____ TBW per weight than non-obese individuals
A
Less
7
Q
Intracellular Fluid has a high concentration of _______, _______, and _______.
A
Potassium (cation), Phosphate (anion), and Magnesium.
8
Q
What maintains the > concentrations of K in ICF?
A
Na-K pump (active transport) ATPase
9
Q
Na:K:ATP
A
3:2:1
10
Q
Extracellular Fluid has high concentrations of ______ and ______.
A
Sodium (cation) and Chloride (anion).
11
Q
What does Albumin in intravascular fluid (plasma) do?
A
Creates osmotic pressure to keep fluid in intravascular space.
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
13
Q
__________ is an expression of the number of osmoles of a solute in a liter of solution.
A
Osmolarity
14
Q
_________ is an expression of the number of osmoles of a solute in a kilogram of solvent.
A
Osmolality
15
Q
Isotonic solutions are approximately _____ mOsm/L
A
285
16
Q
Hypovolemia
A
- Reduce circulating volume
- Loss of extracellular fluid
17
Q
Dehydration
A
- Concentration disorder
- Insufficient water present in relation to sodium levels.
18
Q
_____ and _____ are responsible to normal osmotic activity of the ECF.
A
Sodium and chloride
19
Q
Sodium (ECV and ICV levels)
A
ECV: 140 mEq/L
ICV: 25 mEq/L
(Maintained by Na-K-ATP pump)
20
Q
BBB is or is not tightly packed with cells
A
Is
21
Q
Does Na cross the BBB?
A
No
22
Q
What is the most common electrolyte abnormality in hospitalized patients.
A
Na (Hyponatremia)
23
Q
Biggest risk for Hyponatremia?
A
Cerebral edema
Slide 27 other manifestations of < Na
24
Q
Tx of Hyponatremia
A
- Fluid restriction
- hypertonic saline and diuretic (osmotic or loop)
25
Correction of serum sodium levels too fast can cause ...
Neurological damage and myelinolysis
26
How fast to correct hyponatremia?
1-2 mEq/L/Hour
| Don’t correct Na fast
27
The most common causes of hypernatremia:
- Water deficiency r/t
1. Excessive loss
2. Inadequate intake
others:
Diabetes, Renal dysfunction...
28
Most worrisome manifestations of hypernatremia?
Intarcranial bleeding
>Na shrinks brain, rippling of vessels.
Slide 32 other manifestations of >Na
29
How to correct hypernatremia?
- replace the water deficit.
30
How fast to correct > Na
Slowly (over 24 hours time frame)
31
Potassium is largely responsible for...
Resting membrane potential
32
Potassium is balanced by ___ absorption and _____ excretion.
GI, renal
33
What is the most common electrolyte abnormality in the clinical practice?
Hypokalemia
34
Hypokalemia occurs x2 more in ____ than in _______.
Men, women.
35
< K Causes SLIDE 35
SLIDE 35
36
< K cardiac manifestations: (4)
ST-segment depression
U wave (3.0)
Flat or inverted T waves
Ventricular ectopy
37
< K Neuromuscular manifestations: (3)
Weakness
Decreased reflexes
Confusion
38
Hyper or hypo ventilate pts with < K
Hypo (avoid hyper)
39
Cardiac manifestations of >K
```
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
```
40
To of >K
IV Calcium first, Insulin and Glucose,
41
Upper limit of K for elective procedures:
5.5
42
___ - ___ % of Mg is stored in bone, ___% in cells, and ___% in serum
40-60%, 30%, 1%
43
Where is Mg regulated in the body?
Intestines and Kidney
44
Normal limits of Mg
1.7-2.5
45
Cardiac manifestations of < Mg
```
Flat T waves
U waves
> QT interval
Widened QRS
Atrial and Ventricular PVCs
```
46
Tx of < Mg
IV Mg sulfate 1-2 g over 5 mins.
Followed by continuous IV 1-2 g/hr.
47
```
Clinical Manifestations of > Mg
3-5
4-7
5-10
7-10
10
10-15
15-20
```
3-5: Flushing, N/V
4-7: Drowsiness, < DTR, Weakness
5-10: < BP,
48
Tx of > Mg
Use Ca as antagonist in urgent situations:
- Bradycardia
- HB
- Respiratory depression
49
> Mg _____ ND NMB
Potentiates (lasts longer)
50
Tx of > Ca
NSS
| Loop Diuretics ~ renal excretion of Ca
51
Cardiovascular manifestations of > Ca
HTN
HB
< QT interval
Dysrhythmias
52
Neuromuscular manifestations of >Ca
Muscle weakness
< deep tendon reflexes
Sedation
53
> Ca is 50% caused by _________.
Hyperparathyroidism
54
Tx of < Ca
```
Calcium Chloride (rapid)
Calcium Gluconate (slower)
```
55
Cardiac manifestations of < Ca
```
Dysrhythmias
> QT interval
T-wave inversion
Hypotension
< myocardial contractility
```
56
Pulmonary manifestations of Ca
Laryngospasm
Bronchospasm
Hypoventilation
57
Manifestations of < Ca
```
(Neuromuscular irritability)
Cramps
Weakness
Chvostek sign
Trousseau sign
Seizure
Numbness
Tingling
```
58
Ca functions
Second messenger that couples cell membrane receptors to cellular responses.
59
3 Historical Intra-Operative Fluid Loss
Insensible Loss
Third Spacing Loss
Blood Loss
60
Insensible loss (Historical)
Water loss through
- Urine
- Feces
- Sweat
- Respiratory Tract
61
Correct Insensible loss with _________ at a rate of...
Crystalloid at 2mls/Kg/hr
62
Historical 3rd Space Loss
- Fluid from intravascular to interstitial space
| - Bigger incision (and where) > 3rd space loss
63
Historical 3rd space loss replacement for min, mod, and severe trauma.
Min: 3-4 mL/Kg
Mod: 5-6 mL/Kg
Severe: 7-8 mL/Kg
64
How long does it take for 3rd space loss to become mobilized?
3 days.
| > intravascular volume on the 3rd day. Worry about CHF patients.
65
Goals of NEW perioperative Goal-Directed Therapy (PGDT)
Minimize O2 demand and Optimize CO...
66
NEW PGDT hemodynamic monitoring...
-Frank-Starling (LVEDV) (> preload >contractility)
- Dilution Techniques (PA-Cath)
- Pulse Contour (minimally or noninvasive)
- Esophageal Doppler & Echo
- Measures of Tissue O2
67
New PGDT Protocals:
- Baseline target hemodynamic measures.
- Small fluid bolus to assess Frank-Starling curve
- Maintain end-points with fluids
68
ERAS
| NAGELHOUT pg 358-359
*Look it up
69
Crystalloids cross plasma membranes?
Yes
70
Crystalloids > risk of...
Pulmonary Edema with large volumes
71
Historical Crystalloid replacement with blood loss...
Crystalloid:Blood
3:1
72
T:F not not give Glucose containing solutions except to prevent hypoglycemia in diabetic patients.
True
73
Good chart for Crystalloid vs Colloids
Slide 74
Slide 74
74
Colloids (4)
Albumin
Plasmanate
Hetastarch
Dextran
75
Do Colloids easily cross plasma membrane?
No
| They remain in the intravascular space
No evidence that colloids are better than crystalloids
76
Blood loss replacement with colloids:
1:1
77
Colloids Advantages (1) Disadvantages (3)
< disease transmission
Lack of O2 carrying capacity
Lack of coat factors
> Cost
78
Hetastarch
> volumes can cause dilutional coagulopathy.
Can < factor VII with > Volumes (>1000)
79
FDA in 2015 concluded that...
> mortality and RRT in critically ill pts, especially with sepsis tx with Hetastarch. Stopped using it.
80
Dextran
> Volumes can cause dilution coagulopathy.
< platelet adhesiveness
Potential anaphylactic reactions
Interferes with ability to cross match secondary to agglutination of RBCs
81
5% Albumin
Used for rapid expansion of intravascular fluid volume.
82
25% Albumin
Hypoalbuminemia.
83
S/S of intraoperative blood loss:
> HR
< BP
< CVP
< mixed venous O2
84
Oliguria
<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
Pulse Paradox > than ___ may indicate hypovolemia.
10 mmHg
| 8-10 normal
86
Young healthy individuals may lose ___% of circulating BV without demonstrating clinical signs.
20%
87
Physiologic response to acute blood loss.
-Vasoconstriction (BL of 10% can mask) (Anesthesia also)
88
Indication for blood Transfusion:
Hgb < 6g/dL
| Rarely justified if Hgv > 10
89
Acute blood loss should be tx with _____.
Blood
| too much crystalloids will dilute RBCs
90
Crossmatch:
Incubating (45mins) recipient’s plasma with donors RBCs
91
Emergency transfusions: Universal Donor:
O negative.
| Avoid problems by giving pt’s typed blood ASAP.
92
Type Specific Blood:
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
Typed and Screen:
Blood is screened for most common antibodies after type specific blood
1:10,000 risk of reaction
94
When to order Type and Match vs Type and Screen:
Type and Match if > potential for blood match.
Type and Screen if < potential for blood loss.
95
How long can blood be stored for?
21-35 days at 1-6*C.
96
1 U of Whole Blood = ____ mls and Hct ___%.
450mls. (65 mls of that is citrate preservative) and 40%.
97
1 U of Packed RBCs = ___mls and Hct __%
300mL and 70%.
98
Packed RBCs are indicated for...
Anemia not associated with hemorrhage or shock.
99
Hgb concentrations will > by __ per unit PRBC in a 70Kg adult.
1g/dL
100
Reconstitution of PRBCs in ____ may result in _____.
Calcium, clotting.
101
Advantages of PRBCs vs whole blood
< citrate toxicity with PRBCs
< allergic reaction
102
Platelet administration is indicated intraoperatively when platelet count in < _______ cells/mm3
50,000.
103
Platelet count will > by ______ to _______ with each unit of platelets.
5,000 to 10,000 cells/mm3
104
Platelet Risks
Viral disease transmission
| Bacterial infections
105
Bacterial risk infections with platelets
1 : 12,000
106
Fresh Frozen Plasma:
Contains all plasma proteins, all coats except platelets, factor V and VII
107
FFP is given when...
> PT and PTT more than 1.5 x normal.
Reversal of Warfarin therapy
To correct known factor deficiencies.
108
FFP risks:
Transmission of viral diseases
| Allergic reactions
109
Cryoprecipitate contains high concentrations of ...
Factor VIII, XIII,
Von Willebrand factor
Fibrinogen, Fibronectin
110
(9) Complications of blood therapy
```
Transfusion reactions
Metabolic abnormalities
Citrate intoxication
Transmission of viral diseases
Microaggregates
Hypothermia
Coagulation disorders
Acute Lung Injury
Immunosuppression
```
111
Most frequent transfusion reaction:
Febrile
112
Tx of Febrile Transfusion reaction:
< rate of infusion, antipyretics
| Can continue to give product
113
Allergic Transfusion reaction manifestations:
Urticaria
Pruritus
Occasional facial swelling
114
Allergic TR occurs due to...
Presence of incompatible plasma proteins in donor blood.
115
Allergic TR Tx
IV Antihistamines, Benadryl, stop transfusion.
116
Hemolytic TR
| Result in
Occurs with erroneous unit of blood to patient.
Results in renal failure and DIC.
117
Test to confirm Hemolytic Reaction
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
Tx of Hemolytic reaction
- Stop transfusion!!
- Renal failure (maintain urine output 100mL/hr with LR, mannitol, furosemide)
- Bicarbonate to alkalinity urine
119
5 Metabolic BT abnormalities:
```
> H+
>K
< 2,3-DPG
Metabolic alkalosis (compensation)
Hypocalcemia
```
120
Does pt blood pH > or < after BT?
>
121
Does K > or < with BT
No change
122
Does 2, 3 DPG > or < with storage of blood broducts.
123
< 2, 3 DPG left or right shift
Left
| > affinity of Hgb for O2.
124
Infusion of citrate preservative can result in ________
Hypocalcemia
125
HIV chances
1:1,000,000
126
Hepatitis virus chances
1:60,000
127
Use _______ out of concern of ___________.
Filters, microaggregates
128
Cold patients can have _________ irritability, ___ O2 demand.
Cardiac, >
129
DIC: ___ Platelets, __ PT, __ PTT, __ fibrinogen, __ fibrin split products.
```
Decrease
Increase
Increase
Decrease
Increase
```
130
Tx of DIC
Platelets and FFP.
131
TRALI occurs in ____ of transfusion
6 hours
132
Immunosuppression is a concern for those with __________.
Malignancy
133
Do not give Intraoperative salvage in pts with...
Malignancy
Blood-born disease
Blood contaminated with bowel contents.
134
Cell saver blood is __-__% Hct and pH is _______.
50-60%, alkaline
135
It is contraindicated in pts for hemodilution who are...
Anemia
Sever cardiac disease
Sever neurological disease
136
Hemodilution is a ________ type of transfusion
Autologous
137
Strongly recommended transfusion thresholds:
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
FFP:Platelets:PRBCs
1:1:1
139
Calculations
| SLIDE 160 - 163 *****
SLIDE 160*****
140
EBV Calculations:
```
Premi:
Term:
12 months:
Adult male:
Adult female:
Obese:
```
```
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
ABL =
[EBV X (Hct - target Hct)] / Hct
142
Fluid Calculations: Maint
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
Fluid Deficit =
Maint # x hours of NPO
| Pt don’t drink much fluids in the middle of the night...they sure in the afternoon
144
How to split Deficit?
(Over 3 hours)
1/2 of maintenance X hours NPO for 1st hour
1/4 “ “ for 2nd hour
1/4 “ “ for 3rd hour
145
TRALI occurs most frequently when which two blood products are given?
FFP, Platelets
146
Bacterial contamination occurs at the greatest rate with what blood product?
Platelets
