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Anaesthetics > Fluids > Flashcards

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
Q

define ‘massive haemorrhage’?

A

loss of 1 blood volume within 24h
50% blood volume loss within 3h
rate of blood loss of 150ml/min

26
Q

what is the bloody vicious cycle?

A

haemorrhage -> resus -> haemodilution + hypothermia + acidosis -> coagulopathy -> haemorrhage etc

27
Q

what must be avoided in management in massive haemorrhage?

A

avoid haemodilution, hypothermia, acidosis by managing aggressively and appropriately

28
Q

what are the aims of management of massive haemorrhage?

A

hb > 80g/L
platelet count > 75 x 10^9/L
PT and APTT < 1.5x mean control
fibrinogen > 1.5g/L
avoid DIC

29
Q

when should you anticipate platelet count < 50 x 10^9/L in mx of massive haemorrhage?

A

after 2x volume replacement

30
Q

what is done if ?DIC

A

treat underlying cause if possible

31
Q

what is the procedure to restore circulating volume?

A

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
Q

examples of crystalloids?

A

hartmann’s
saline
5% glucose
4% glucose with 1/5 saline

33
Q

examples of colloids?

A

gelofusion
geloplasma

34
Q

how do crystalloids work?

A

contain water + electrolytes (most isotonic with ECF)
pass freely through semipermeable membranes

35
Q

where will saline-based crystalloids (e.g. hartmann’s) distribute?

A

within exctracellular space

36
Q

why is 5% glucose not recommended in fluid resus?

A

effectively giving free water because glucose is metabolised and the restulting water restributes into all the compartments (going mainly intracellularly)

37
Q

how are colloids different to crystalloids?

A

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
Q

examples of carrier solution used in colloids?

A

saline (e.g. gelofusion, voluven)
hartmann’s-like (i.e. balanced, e.g. geloplasma)

39
Q

colloids are ____ readily filtered at the kidney than crystalloids

A

less

40
Q

complications of starch colloid?

A

excess renal complications and mortality compared to crystalloids

now only gelatin colloid and crystalloids used in UK

41
Q

advantages of crystalloids to colloids?

A

cheap
easy to manufacture and store
long shelf life
no anaphylactic rxn

42
Q

advantages of colloids to crystalloids?

A

smaller volume of infusion needed
remain longer in intravascular space

43
Q

disadvantages of colloids to crystalloids?

A

more expensive
small risk of anaphylaxis

44
Q

what + how much fluid in theatre?

A

500ml resus bolus (saline/hartmann’s) over 15 min - repeat 4x if needed
maintenance doses per NICE

45
Q

hx of hypovolaemia?

A

vomiting, diarrhoea
intestinal obs
fluid intake reduced
thirst

46
Q

clinical signs of hypovolaemia?

A

low UO
increased CRT
tachy
postural HTN - late sign
decreased consciousness
low CVP

47
Q

lab markers of hypovolaemia?

A

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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