fluid and electrolytes Flashcards
what do third space losses depend on?
location, duration of surgical procedure, amount of tissue trauma, temp, ventilation
How much third spacing losses do you get with a superficial surgical trauma and what is an example of this procedure?
1-2 ml/kg/hr
knee arthroscopic surgery
How much third spacing losses do you get with a minimal surgical trauma and what is an example of this procedure?
2-3 ml/kg/hr
head and neck surgery
hernia
knee surgery
How much third spacing losses do you get with a moderate surgical trauma and what is an example of this procedure?
5-6 ml/kg/hr
open hysterectomy
chest surgery
How much third spacing losses do you get with a severe surgical trauma? what is an example?
8-10 ml/kg/hr
AAA repair
nephrectomy
dissecting aortic aneurism
what is the osmolarity of:
0.9% NaCl
0.45% NaCl
glucose 5%
308
154
278
what are the formulas for calculating osmolarity with and w/o K+?
2 (Na +K+) + (BUN/0.8)+(glucose/16)
2(Na) +(BUN/0.8)+ (glucose/18)
what are the 5 things that volume regulation depend on?
ADH renin/angiotensin/aldosterone baroreceptors stretch receptors in the atrium-juxtaglomerular apparatus cortisol-mineralocorticoid activity
what is the rule for maintenance fluid?
4-2-1 rule
4 ml/kg/hr for the first 10 kg
2 ml/kg/hr for the next 10 kg
1 ml/kg/hr for the remaining kg
what is a standard order for fluid in the ICU?
I L of 0.45 NaCl 20 KCl at 125 mL/hour
(takes about 8 hours)- 3L in 24 hours
what is the maintenance replacement for Na? K?
2-3 mm/kg/day
0.5-1 mm/kg/day
How do you calculate resuscitation for for NPO losses?
of hours NPO X maintenance fluid requirement
how much fluid is lost for bowel prep?
up to 1 L
how much is in 1 unit of packed RBC’s?
how much does one unit raise the hemoglobin?
1 unit = 250 mL
Hct = 70-80%
raises the hgb 1 gm/DL
-infuse is with NS
what are the indications for giving platelets?
thrombocytopenia
in surgery when plt count is <50,000
what should your platelet count be prior to surgery?
> 90,000
what is the composition of FFP?
must be ABO compatible but does not require crossmatching
coagulation factors and no platelets
what are the indications of FFP and what is the dosage that you give it?
15 ml/kg
factor deficiencies
reversal of coumadin effect (fast acting)
TTP
interopertivly when PT and PTT are >1.5 normal
must be used within 24 hours! or factors V and VIII levels will decrease (break down)
what is in cryopercipitate?
fibrinogen (200 mg)*
vWF
factor VIII
Factor XIII
what type of reaction is a FNHTRs?
ABO incompatability-IgM or IgG mediated (not allergic IgE)
what happens when you get hemolytic anemia from a blood transfusion? what are the symptoms?
rapid destruction of donor RBCs by preformed antibodies
* compliments activation and intravascular hemolysis- hgb released in the blood gets trapped in the kidneys
Fever, Flank Pain, and red or brown urine
Most common organism transfered through blood components?
CMV
what is the total ionized calcium replacement it current serum ionized ca is 1.0-1.10 mmol/L?
1 gram ca chloride
what is the total ionized calcium replacement it current serum ionized ca is 0.85-0.99 mmol/L?
2 grams ca chloride
what is the total ionized calcium replacement it current serum ionized ca is 0.75-0.84 mmol/L?
3 grams ca chloride
what is the total ionized calcium replacement it current serum ionized ca is <0.75 mmol/L?
call for backup
what happens when IV calcium extravagates?
irritation and muscle necrosis
what are EKG finding for hypocalcemia?
prolonged QT segment
what are the EKG changes for hypercalcemia?
Short QT
depressed T wave
bradycardia
heart block
