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Acute Medical Conditions > Fluid Balance > Flashcards

Fluid Balance Flashcards

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USMLE® Step 1 flashcards
1
Q

What happens if intravascular space becomes depleted?

A

Fluid moves from intracellular to intravascular to try to compensate

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2
Q

What affects fluid in each compartment?

A

Available water
Hydrostatic pressure
Oncotic pressure
Solute concentration

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3
Q

What is hydrostatic pressure?

A

Pressure which blood exerts on the vessel wall created by systole and intravascular volume

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4
Q

How is oncotic pressure created?

A

Pull of proteins in the plasma, albumin create osmotic pressure holding water in the intravascular space

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5
Q

What are the indications of the fluid status of intravascular fluid?

A

Pulse, BP, CVP, urine output, capillary refill, O2 saturation, peripheral skin colour + temp, core temperature, U+E

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6
Q

What are the key requirements for adequate circulation and oxygenation?

A 
Effective cardiac function
Systemic vascular resistance
Sufficient blood volume
Appropriate distribution of fluids 
Oncotic pressure
Hydrostatic pressure
Sufficient ventilation
Sufficient haemoglobin
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7
Q

What are the indications of the fluid status of intracellular fluid?

A 
Thirst
Dry oral membranes 
Poor skin turgur
Headache
Concentrated urine
Lower urine output
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8
Q

What are the indications of fluid status of interstitial fluid?

A

Assessment of skin for signs of oedema

Excess fluid in interstitial space can be referred to as third spacing

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9
Q

What is a good indicator of adequate circulation?

A

MAP

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10
Q

What is the minimum MAP for tissue perfusion?

A

60 mmHg

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11
Q

What is the normal MAP value?

A

70-110 mmHg

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12
Q

How do you manually work out MAP?

A

[(diastolic x 2) + systolic] / 3

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13
Q

What is central venous pressure?

A

Invasive hemodynamic assessment using a central venous catheter and transducer system

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14
Q

What is the normal CVP range?

A

3-8 mmHg

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15
Q

What does high CVP pressure mean?

A

Fluid excess

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16
Q

What does low CVP pressure mean?

A

Fluid deficit

17
Q

What are some of the causes of fluid deficit?

A

NMB, diarrhoea, vomiting, haemorrhage, fever, burns, wounds, excess diuretics

18
Q

What are some of the potential causes of fluid excess?

A

Retention of sodium and water, heart failure, liver failure, renal failure, steroids, excess IV fluid administrations or blood transfusion

19
Q

What is pulmonary oedema?

A

Accumulation of fluid in the lungs from a massive volume overload or left ventricular failure
It is a medical emergency

20
Q

What are the symptoms of pulmonary oedema?

A

SOB, use of accessory muscles, hypoxia, anxiety, restlessness, coarse crackles on ausculation and percussion, pink frothy fluid

21
Q

What are the treatments for pulmonary oedema?

A

Urgent medical assessment, assess oxygenation + tissue perfusion + breathlessness, position for max lung expansion + coughing, high flow O2,
diuretics, treat the cause

22
Q

What are the types of hypovolaemia?

A 
Covert compensated (reduced intravascular volume without clinical signs)
Overt compensated (BP maintained but tachy, wide pulse pressure, cool peripheries)
Decompensated hypovolaemia (shock£
23
Q

How do you manage fluid deficits?

A

Risk of fluid loss, ascertain cause, fluid replacement, fluid challenge, electrolyte replacement, monitor fluid balance, monitor U+E

24
Q

What are the short term venous access devices!

A

Peripheral catheter

Non-tunnelled CVAD

25
Q

What are the intermediate use venous access devices?

A

Midline catheter

PICC

26
Q

What are the long term venous access devices?

A

PICC
Tunnelled CVAD
Implantable port

27
Q

What are isotonic solutions?

A

Concentration of dissolved particles equal to that of intracellular fluid (0.9% sodium chloride, 5% dextrose, Hartmanns)

28
Q

What are hypotonic solutions?

A

Tonicity less than intracellular fluid

Osmotic pressure draws water into the cells from extra cellular fluid (0.45% sodium chloride)

29
Q

What are hypertonic solutions?

A

Tonicity greater than intracellular fluid

Osmotic pressure is unequal inside and outside cell (high concentration dextrose)

30
Q

What are crystalloids?

A

Small molecule solutes containing electrolytes and glucose (0.9% sodium, 5% dextrose in water)

31
Q

What are colloids?

A

Large molecules containing gelatines, starches (fresh frozen plasma, blood, albumin)

32
Q

What should be first line treatment for low intravascular blood volume?

A

Crystalloids

Acute Medical Conditions (18 decks)

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