Fluid Management Flashcards
The most important oncotically active constituent of ECV?
If out of normal range it is going to impact interstitial fluid and third spacing
Albumin
- Look at their feet and hands (ex: __ patient)
- If tachycardic, give __ and see if HR decreases (patient’s HR could be elevated from anxiety)
- If HCT gets __ lets us know our fluid volume status is off
- CHF
- 500 NS
- hemoconcentrated
- Exchange Btw Fluid Compartments:
- Plasma communicates continually with __ via __
- __ and __ dictate fluid movement
- ISF and ICF
- __ dictate fluid movement
- Main determinant of Extracellular osmotic pressure?
- Main determinant of Intracellular osmotic pressure?
ISF capillary pores osmotic forces and hydrostatic pressures osmotic forces sodium potassium
Fluid deficit = ?
maintenance requirement x the number of hours patient NPO
- For a 3 hour case would most likely get a ?
- Monitoring __ is vital task of anesthetist.
- Foley
- blood loss
Blood Loss:
*We can replace blood loss __ or __
~ 3:1 = 3 cc of __ per 1 cc of blood loss - do this if think patient can tolerate other fluids than blood
~Quicker to give someone blood if they have history of __ with __. Also monitor oxygen saturation.
*1:1 or 3:1
~Crystalloid
~CAD with open heart surgery
Estimated Blood Volume (EBV):
Adults: Men? Women?
Obese patients will have increased __, due to blood going to the adipose tissue. EBV and their not doing well and their Hct is dropping - may need to give blood sooner
Men = 75 ml/kg Women = 65 ml/kg
circulating blood volume
Allowable Blood Loss - determines how much blood you can lose to reach a particular Hct. Helps design appropriate plan and time to transfuse patient.
Equation?
ABL = EBV x (patients Hct - allowable Hct) /
patients Hct
Allowable Blood Loss (ABL):
You determine how low the hematocrit can be. There is no exact number base it off of __ (Ex: heart disease don’t let get much lower than __ before transfusing).
Allowable blood loss is based on ?
When to transfuse is based on the setting you practice in and what everyone believes.
co-morbidities
30/29
patient’s comorbidities
Evaporative loss related directly to ___ and ___.
Third space loss due to ___ and ___ caused by redistribution of fluids.
-Trauma, infection, burns
surface area of surgical wound and duration of exposure
massive fluid shifts and intravascular volume deficit
Perioperative Fluid Plan:
- 1st hour starts when ?
- __ = only happens when the case has started and the incision has been made
- In the first hour, no __ yet
you get the IV
third space loss
blood loss
IV Fluid Therapy - Crystalloids:
- Hypotonic Solutions - (?) -Replaces? -Called? -Examples?
- Hypertonic Solutions -Used for? -Examples?
*253 water loss maintenance fluids D5W Hyponatremia and shock D5 1/2 NS (432) 3% NS (1026)
IV Fluid Therapy - Crystalloids:
- Isotonic Solutions - (?)
- Replaces?
- Called?
- Examples?
- 300
- water and electrolyte loss
- replacement fluids
- NS or LR
*__ = what we usually give. Close to same osmolarity as serum, stays in intravascular compartment, thus it expands it.
*__ = draw fluid into the intravascular space from the interstitium (give this in ?)
*isotonic solutions
*hypertonic solutions
neuro
Avoid __ if giving blood, there could be some clotting.
crystalloid
- __ = High molecular weight. Administered in a volume equivalent to volume of blood lost.
- Half life in circulation is __ but can be __
- Used for __ in patients with severe __
*Colloid Solutions 16 hours 2-3 hours fluid resuscitation severe intravascular fluid deficits
- Belly open - at risk for evaporative loss - ? fluid
- Going to the kidneys?
- Interstitial fluid
- Intravascular fluid (plasma)
Renal don’t use fluids that contain potassium, __ contains potassium
Lactated Ringers
Blood Colloid Solution - Albumin: ~Obtained from ? ~Does not contain \_\_ or \_\_ ~Available as \_\_ or \_\_. Common in OR? -Contains \_\_ at 5x the normal concentration, so it can easily expand the \_\_
~fractionated human plasma ~coagulation factors or blood group antibodies ~5% or 25% solution, 5% solution -purified albumin -plasma volume
***Dextran:
___ used for volume expansion
-(very similar in expansion properties as __)
___ used for prevention of thrombosis
*Side effects: ?? +
___ (1:3000 patients)
___ (can happen if you exceed doses of 20 ml/kg in 24 hours)
Dextran 70 albumin 5% Dextran 40 non-cardiac pulmonary edema (d/t the toxic effects on pulm capillaries) interference with crossmatching anaphylactoid reaction platelet inhibition
- **Hespan:
- As effective as albumin for __
- __
- __ than albumin
- Stored in the ___ for __ and __ excreted
- Causes? this reduces __ levels by 50% (prolonged PTT, interferes with clotting)
- Doses > than ? can have issues with allergic rxn and bleeding
- volume expansion
- nonantigenic
- less expensive
- reticuloendothelial system for several hours
- renally excreted
- coagulopathy due to dilutional thrombocytopenia
- factor 8
- > 20 mL/kg
If your patient needs ___ it is ok to a certain extent but if you continue to need ___ for intravascular volume you should give blood.
You make the decision to switch from ?
colloid
colloid support
colloid to blood
1) Support urine output better?
2) Less likely to cause pulmonary edema?
3) Associated with coagulation and antigenic problems?
4) Better at restoring severe intravascular volume deficits via oncotic P?
5) Inexpensive?
6) Fluid of choice for hypoproteinemia?
7) More tissue edema occurs with?
1 - crystalloids 2 - crystalloids 3 - colloids 4 - colloids 5 - crystalloids 6 - colloids 7 - crystalloids
Blood Products:
Risk of __ is they dilute circulating blood products (dilute Hct).
Risk of systemic ischemia is decreased by maintaining your patients
*Risk:
1:1,000,000 at risk for __
1:300,000 at risk for __
fluid administration
hematocrit
HIV
Hepatitis
