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Intro To AA > Fluid Therapy And Replacement > Flashcards

Fluid Therapy And Replacement Flashcards

1
Q

4 things that rate depends on:

A
  1. Permeability of substance
  2. Concentration differences
  3. Pressure differences
  4. Electrical potential
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2
Q

Net movement of water across a semipermeable membrane due to a difference in solute concentrations

A

Osmosis

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3
Q

Number of osmoles/liter

A

Osmolarity

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4
Q

Number of osmoles/kilogram of water

A

Osmolality

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5
Q

Normal human serum osmolality

A

275-299 miliosmoles/kilogram

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6
Q

Total body water

A

60% of body weight, 42L

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7
Q

Intracellular fluid

A

67% of TBW, 28L

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8
Q

Extracellular fluid

A

33% of TBW, 14L

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9
Q

Interstitial fluid

A

25% of TBW, 11L

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10
Q

Plasma fluid (intravascular)

A

8% of TBW, 3L

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11
Q

Volume of water in males

A

60%

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12
Q

Volume of water in females

A

50-55%

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13
Q

Volume of water in newborns

A

75%

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14
Q

Volume of water in obese patients

A

As low as 45%

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15
Q

Intracellular fluid body compartment (4)

A
  1. Comprises 2/3 of TBW
  2. Osmotic pressure determined by K+
  3. High protein content
  4. Controlled by ATP pump
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16
Q

Extracellular fluid body compartment (3)

A
  1. Comprises 1/3 of TBW
  2. Osmotic pressure determined by Na+
  3. Subdivided into interstitial and intravascular (plasma)
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17
Q

Interstitial extracellular fluid compartment (2)

A
  1. Very little free fluid

2. Reservoir for intravascular compartment

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18
Q

Intravascular extracellular fluid compartment (3)

A
  1. Restricted by vascular endothelium
  2. Electrolytes pass freely
  3. Plasma proteins usable to pass (albumin)
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19
Q

Crystalloids (3)

A
  1. Aqueous solutions of ions (glucose)
  2. IV half life is only 20-30min
  3. Large volumes cause edema
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20
Q

Movement of water in hypotonic fluids

A

Water will move intracellularly

-decreases IV volume

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21
Q

Hypotonic fluids osmolarity

A

<240 MOSM/L

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22
Q

Uses of hypotonic fluids (3)

A
  1. Hypernatremia
  2. Diabetic ketoacidosis
  3. Hyperosmlar/hyperglycemia
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23
Q

4 risks of hypotonic fluids

A
  1. Increase ICP
  2. Worsens hypotension
  3. Hyperglycemia
  4. Hemolysis
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24
Q

Water movement of hypertonic fluids

A

Mostly remains in ECF

-pulls from ICF

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25
Q

Osmolarity of hypertonic fluid

A

> 310 MOSM/L

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26
Q

2 uses for hypertonic fluid

A
  1. Plasma expanders

2. Reduce cerebral edema

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27
Q

4 risks of hypertonic fluids

A
  1. Hyperchloremic metabolic acidosis
  2. Pulmonary edema
  3. IV infiltration
  4. Cellular dehydration
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28
Q

Serum osmolality of isotonic fluids

A

275-299 MOSM/KG

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29
Q

Use of isotonic fluids

A

Replace extracellular volume

30
Q

Risk of isotonic fluids

A

Fluid overload (caution in cardiac/renal pts)

31
Q

2 things that lactated ringers has:

A

Potassium and calcium

32
Q

3 cautions with lactated ringers

A
  1. Renal pts
  2. Hyperkalemia pts
  3. Do NOT use with blood administration
33
Q

Osmolarity of normal saline

A

308 MOSM/KG

34
Q

When is normal saline preferred?

A

Renal pts
Brain injury
Blood administration

35
Q

What can large volumes of normal saline cause?

A

Hyperchloremic metabolic acidosis

36
Q

What does colloids contain?

A

Proteins and large glucose polymers

37
Q

Intravascular half life of colloids

A

3-6hrs

38
Q

Two types of albumin

A

5% (iso-oncotic)

25% (hyper-oncotic)

39
Q

How long do effects of albumin last?

A

16-24hrs

40
Q

What 2 types of dextran’s are there?

A 
Dextran 70 (macrodex): molecular wt 70,000
Dextran 40 (rheomacrodex): molecular wt 40,000
41
Q

3 complications of dextran:

A
  1. Anti platelet effects
  2. Acute kidney injury
  3. Anaphylactic rxns
42
Q

Synthetic colloid derived from natural polysaccharides

A

Hydroxyethyl starches (HES)

43
Q

Duration of volume with hydroxyethyl starches

A

2-5hrs

44
Q

3 complications with hydroxyethyl starches

A
  1. Pruritus from tissue storage
  2. Coagulopathy
  3. Renal toxicity
45
Q

4 signs of laboratory analysis

A
  1. Increasing HCT/HB
  2. Hypernatremia
  3. BUN: CR ratio > 10:1
  4. Progressive metabolic acidosis
46
Q

7 signs of intraop hypovolemia

A
  1. Tachycardia
  2. Poor urine output
  3. Decreased BP
  4. Wavering pulse ox
  5. Arterial line respiratory variation
  6. Hypernatremia
  7. Decreased CVP
47
Q

5 signs of intraop hypervolemia

A
  1. Rales
  2. Frothy secretions
  3. Hyponatremia
  4. Polyuria
  5. Peripheral edema
48
Q
  • BP
  • HR
  • Urine Output
  • Central Venous Pressure (CVP)
  • Mixed venous oxygen saturation
A

Static parameters

49
Q
  • Respiratory variation
  • SV
  • L ventricular size
A

Dynamic parameters

50
Q

CVP RA normal pressure

A

2-7mmHg

51
Q

SVV equation

A

SVmax-SVmin/SVmean

52
Q

Normal SVV

A

10-15%

53
Q

PPV equation

A

PPmax-PPmin/PPmean

54
Q

Normal PPV

A

10-15%

55
Q

What SVV or PPV suggests that pts may be responsive to fluid therapy?

A

> 15%

56
Q

Arterial pressure tracing estimates:

A

CO
PP
SV variation with ventilation

57
Q

2 ways to perform L ventricular size:

A 
Transesophageal echocardiography (TEE)
Transthoracic echocardiography (TTE)
58
Q

TEE

A

Invasive

Better visualization

59
Q

TTE

A

Less invasive

Visualization harder

60
Q

Daily maintenance requirements

A

2500ml/day

61
Q

4 replaces fluids

A
  1. Maintenance requirements
  2. Deficits
  3. Estimated Blood loss
  4. Other surgical fluid losses
62
Q

4-2-1

A

First 10kg - 4ml/kg/hr
Next 10kg - 2ml/kg/hr
Each kg above 20 - 1ml/kg/hr

63
Q

Bowel prep deficit

A

500ml

64
Q

4x4 sponges holds blood loss

A

10ml

65
Q

Laparotomy pads (laps) holds blood loss

A

100-150ml

66
Q

Replacement of EBL:crystalloid

A

1:3

67
Q

Replacement of EBL:colloid

A

1:1

68
Q

Surgical evaporative loses minimal

A

2-4 ml/kg/hr

69
Q

Surgical evaporative loses moderate

A

4-6 ml/kg/hr

70
Q

Surgical evaporative loses severe

A

6-8 ml/kg/hr

71
Q

Internal redistribution of fluid leading to fluid shifts and loss of IV fluid

A

3rd space fluid loss

72
Q

Replacement of preexisting fluid deficits over 3 hr

A

1/2 deficit in 1st hr
1/4 deficit in 2nd hr
1/4 deficit in 3rd hr

Intro To AA (8 decks)

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