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Fluids Flashcards

1
Q

surgical pts receive _% of transfused allogenic blood in the UK?

A

40

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2
Q

what is the purpose of a RBC transfusion?

A

improve O2 carrying capacity of blood

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3
Q

what are indications for RBC transfusion?

A

Hb < 70g/L - strongly indicated
Hb < 50g/L - essential
Hb 70-100g/L - unclear
symptomatic pt should be transfused, but cardiopulmonary reserve should be assessed

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4
Q

at what rate should transfusion be given?

A

according to rate of according loss

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5
Q

how is a decision to transfuse made?

A

individual pt basis - not all pt agree
pt need not be transfused to achieve normal [Hb]

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6
Q

what factors should be considered when deciding to RBC transfuse pt?

A
  • cause and severity of anaemia
  • pt ability to compensate for anaemia
  • rate of ongoing blood loss
  • likelihood further blood loss
  • risk of CAD
  • risk v benefit of transfusion
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7
Q

risks of RBC transfusion?

A

immediate immune or non-immune reaction
delayed immune or non-immune reaction

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8
Q

examples of immediate immune reactions?

A

acute haemolytic transfusion - abo incompat
febrile non-haemolytic transfusion rxn
allergic rxn
TRALI

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9
Q

examples of immediate non-immune reactions?

A

volume overload
ARDS
massive transfusion complications
bacterial infection

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10
Q

examples of massive transfusion complications?

A

coagulopathy
hypothermia
hyperkalaemia
acidosis
citrate toxicity

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11
Q

examples of delayed immune reaction?

A

GVHD
delayed haemolytic transfusion rxn
alloimmunisation

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12
Q

examples of delayed non-immune reaction?

A

viral infection (HIV, HBV, HCV, CMV, vCJD)
iron overload

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13
Q

what else is needed, besides RBCs, to achieve haemostasis?

A

platelets
clotting factors
fibrinogen

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14
Q

indications for platelet component therapy?

A

consider endogenous platelet function + count

if > 10 x 10^9/L in absence of active bleeding, no need to transfuse as patients are considered stable

if < 50 x 10^9/L and invasive procedure OR actively bleeding pt, then need to transfuse to increase count to above this value

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15
Q

how much does each dose of platelet bag increase the platelet count by?

A

~20 x 10^9/L in most adults

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16
Q

what is the volume of a typical unit of FFP?

A

150-200ml

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17
Q

how is FFP stored?

A

frozen - so need to factor in thawing time when ordering (20 mins)

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18
Q

what does FFP contain?

A

all clotting factors + components of fibrinolytic and component systems

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19
Q

indications of FFP?

A

empirically for acquired coagulopathy (prolonged INR or APTT):

  • therapeutically when bleeding
  • prophylactically in non-bleeding prior to surgery/invasive procedures
20
Q

what is cryoprecipitate?

A

cryoglobulin fraction of plasma
contains fibrinogen (150-300mg), factors 8 and 13, vWF

21
Q

indications for cryoprecipitate?

A

acquired coagulopathy related to haemorrhage, trauma, sepsis

22
Q

what is the aim in cryoprecipitate therapy?

A

keep fibrinogen > 1.5g/L

23
Q

dose of cryoprecipitate therapy?

A

usually 10 pack dose - contains 1.5-3g fibrinogen

24
Q

which patient groups are prediposed to bleeding?

A

liver disease
renal disease
congenital coagulopathy
taking antiplatelet or anticoagulant drugs
Jehovah’s witnesses

25
define 'massive haemorrhage'?
loss of 1 blood volume within 24h 50% blood volume loss within 3h rate of blood loss of 150ml/min
26
what is the bloody vicious cycle?
haemorrhage -> resus -> haemodilution + hypothermia + acidosis -> coagulopathy -> haemorrhage etc
27
what must be avoided in management in massive haemorrhage?
avoid haemodilution, hypothermia, acidosis by managing aggressively and appropriately
28
what are the aims of management of massive haemorrhage?
hb > 80g/L platelet count > 75 x 10^9/L PT and APTT < 1.5x mean control fibrinogen > 1.5g/L avoid DIC
29
when should you anticipate platelet count < 50 x 10^9/L in mx of massive haemorrhage?
after 2x volume replacement
30
what is done if ?DIC
treat underlying cause if possible
31
what is the procedure to restore circulating volume?
wide bore peripheral cannula (14G or more) give enough warmed crystalloid/colloid/blood aim to maintain normal BP and UO (>30ml/hr) monitor CVP keep pt warm blood loss is often underestimated!
32
examples of crystalloids?
hartmann's saline 5% glucose 4% glucose with 1/5 saline
33
examples of colloids?
gelofusion geloplasma
34
how do crystalloids work?
contain water + electrolytes (most isotonic with ECF) pass freely through semipermeable membranes
35
where will saline-based crystalloids (e.g. hartmann's) distribute?
within exctracellular space
36
why is 5% glucose not recommended in fluid resus?
effectively giving free water because glucose is metabolised and the restulting water restributes into all the compartments (going mainly intracellularly)
37
how are colloids different to crystalloids?
are larger molecular wt substances (e.g. gelatins/starches) suspended (not disolved) in carrier solution don't pass through semipermeable membrane stay in IVC longer
38
examples of carrier solution used in colloids?
saline (e.g. gelofusion, voluven) hartmann's-like (i.e. balanced, e.g. geloplasma)
39
colloids are ____ readily filtered at the kidney than crystalloids
less
40
complications of starch colloid?
excess renal complications and mortality compared to crystalloids now only gelatin colloid and crystalloids used in UK
41
advantages of crystalloids to colloids?
cheap easy to manufacture and store long shelf life no anaphylactic rxn
42
advantages of colloids to crystalloids?
smaller volume of infusion needed remain longer in intravascular space
43
disadvantages of colloids to crystalloids?
more expensive small risk of anaphylaxis
44
what + how much fluid in theatre?
500ml resus bolus (saline/hartmann's) over 15 min - repeat 4x if needed maintenance doses per NICE
45
hx of hypovolaemia?
vomiting, diarrhoea intestinal obs fluid intake reduced thirst
46
clinical signs of hypovolaemia?
low UO increased CRT tachy postural HTN - late sign decreased consciousness low CVP
47
lab markers of hypovolaemia?
raised haematocrit increased serum lactate increased urea disproportionate to creatinine metabolic acidosis increased plasma osmolarity SV rises on colloid challenge

Anaesthetics (5 decks)

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