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SU-18 ER > FLuids > Flashcards

FLuids Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Reason for Fluid Resuscitation

A
  1. Restore volume lost to sustain critical organ perfusion
  2. Maintain oxygen carrying capacity for adequate cellular oxygen delivery
  3. Correct derangements in coagulation
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2
Q

Types of Fluids Used (primary volume expanders)

A

Crystalloid
Emergency release blood (O Neg)
Pts blood type

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3
Q

Lethal Triad

A

Hypothermia
Acidosis
Coagulopathy

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4
Q

why’do we care about fluid rescuitation

A

transportation of gases nutrients and wastes

generation of electrical activity for body function and health

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5
Q

volume loss patho

A

decreased volume causes stimulation of cardiac stretch and baroreceptors = lowered BP and venous return = decreased SV

stimulation of sympathetic NS = increased HR, vasoconstriction, ventricular contraction

kidneys: activate RAAS and ADH (water retention and increased thirst)

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6
Q

volume loss 2/2 hemorrhage causes

A

activation of coagulation system

platelet deposition and local medaiteors in effort o seal injury site and prevent further blood loss

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7
Q

electrolytes in intracellular space

A

potassium
magnesium

no Ca, little NA, Cl

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8
Q

extraceullar space elexttrolyes

A

Na, Cl

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9
Q

ECF composed of

A

20% of all TBW

interstitial, vascular, transcelluar

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10
Q

interstitial space

A

transport mediator

vascular compartment with cells

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11
Q

vascular compartment

A

blood

essential for transport of electrolytes, gasses, nutrients, wastes

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12
Q

interstitial fluid

A

transport vessel for electrolytes and gases, nutrients, wastes between cellular and vascular compartments

serves as reservoir

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13
Q

interstitial fluid as a reservoir

A

mucopolysaccharide gel

aids body in times of hemorrhagic and volume loss

helps try to maintain

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14
Q

transcellular compartment

A

separation of thin membrane material

fluid accumulates here when theird spacing

not available for exchange

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15
Q

4 forces of fluid transfer

A
  1. capillary filtration pressure
  2. capillary colloid osmotic pressure
  3. interstitial fluid pressure
  4. tissue colloid osmotic pressure

these forces oppose each other so that there is little fluid left in interstitial space

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16
Q

capillary filtration pressure

A

mechanical force

forces water out of capillaries and into intersitium

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17
Q

capillary colloid osmotic pressure

A

pulls water back into capillary
[osmotic pressure

generated by plasma proteins

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18
Q

interstitial fluid pressure

A

opposes movement of water OUT of capillary

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19
Q

tissue colloid osmotic pressure

A

pulls water from capillary to interstitial space

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20
Q

electrolytes

A

substance that dissociate in solution to form charged particles

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21
Q

non electrolytes

A

dont dissociate

glucose and urea

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22
Q

hypovolemia

A

any condition of EC volume reduction that causes reduction in tissue perfusion

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23
Q

absolute hypovolemia

A

volume has LEFT the body

hemorrhage, burns, vomiting, polyuria, evaporation

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24
Q

reactive hypovolemia

A

fluid is still within the body but not available

capillary leak, ascites, effusion, vasodilation

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25
Q

sensible loss

A

early measured or quantified by individual or clinician

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26
Q

insensible loss

A

volume loss that is not easily measured or quantified

27
Q

classic signs of hypovolemia

A

tachycardia
HoTN
poor peripheral perfusion (weak pulse, prolonged refills)

AMs or ACS 2/2 poor global perfusion

28
Q

outliers of hypovolemia s/s

A

intraabdominal bleed MAY cause paradoxical vagal stimulation THEREFORE present with bradycardia

29
Q

Cushing reflex

A

intracranial bleed causes HTN and bradycardia (as opposed to normal hypovolemia signs)

30
Q

IV access

A

large bore (NST 18 or less)

2 sites

rate of infusion size and pressure matter

can alter diameter and gravity

31
Q

options other than peripheral lines

A 
central lines (fem line) 
IO placement 
saphenous vein cut down
32
Q

2 components of fluid therapy

A

replacement therapy

maintenance therapy

33
Q

replacement fluid therapy

A

corrects exiting water and electrolyte deficits

GI/GU dz, bleeding, thrid spacing

34
Q

maintenance fluid thearpy

A

replace ongoing losses of water and electrolytes under what would be considered NORMAL conditions

I.e. post op

35
Q

crystalloid or colloid?

A

there is no clinical difference in survival BUT crystalloid is recommend

36
Q

preferred agent of fluid replacement

A

crystalloid

37
Q

crystalloid

A

low onchotic pressure = does not last

substantial shift between vascular space and cellular space

3:1 rule

38
Q

3:1 rule crystalloid

A

for every 1 L of fluid loss, 3L of fluid replaced

39
Q

lactated ringer

A

buffering of academia

increase of cytokine release

hyperkalemia is a risk (caution in renal pts)

increased electrolytes, lactic acidosis risk

40
Q

normal saline

A

slightly hyperosmolar

risk of causing hyperchloremic metabolic acidosis if gibing large volumes

41
Q

crystalloid (LR or NS) can induce

A

neutrophil activation

42
Q

MC colloid used

A

ALBUMIN

osmotic pressure
unable to go into extravascular space BUT NOT substitute for blood

43
Q

cons of colloid

A

no evidence of improved outcomes compared to crystalloid

more expensive

if HEMORRHAGIC or SEPTIC vessels become so permeable that heven this high load is not able to stay in vessel

44
Q

fresh frozen plasma

A

liquid portion of blood

unconcentrated source of clotting factors

independent of platelets

45
Q

plamsa contains

A 
albumin 
fibrinogen
globulins
glucose
lytes
hormones and CO2
46
Q

universal donor of FFP

A

AB

47
Q

when do we use FFP?

A

correction of bleeding that is secondary to a factor deficiency

urgent reversal of Coumadin (Vitamin K takes too long)

48
Q

when do you transfuse blood?

A

following rapid transfusion of 2-3 L of crystalloid that had modest improvement in hemodynamics

pts who initially improved then deteroiated

hemodynamic instability from gross blood loss

49
Q

goal of transfusion

A

PERFUSION

do not transfuse just to appease lab criteria, transfuse patients that need it

50
Q

emergency release

A

4:4:6

PRBCs:FFP:PLT

NOT whole blood

51
Q

massive transfusion

A

need of >10 u blood in 24 hrs

massive hemorrhage (FFP and PLT needed)

1:1:1

52
Q

massive transfusion in trauma bay uses this system

A

Belmont

allows for rapid transfusion, warming

no risk of air emboli

can be loaded and ready in 1 minute

53
Q

universal blood donor

A

O neg

54
Q

universal platelet donor

A

NONE

55
Q

crucial value of low platelet

A

< 50,000

1 unit of platelet = 10,000 increase in concentration

56
Q

when do you give platelets?

A

part of Er or massive protocol

prevention of bleeding in those with known thrombocytopenia (<10K)

57
Q

when would you use hypertonic saline?

A
  1. head trauma

2. hyponatremia

58
Q

head trauma and hypertonic saline

A

intracranial hemorrhage

minimized risk of cerebral edema

NEVER used as a volume expander

3% MC used

59
Q

hyponatremia and hypertonic saline

A

3%
nephrology management

if pt is hyponatremic and seizing, load them with tis

60
Q

ocygen carrying rescucitation

A

synthetic blood that was proposed to be used to increse O2 delivery

studies showed that O2 doesnt last, causes more issues (I.e. ischemia)

61
Q

when would you increase infusion flow rate?

A

burns
dehydration
shock
DKA

62
Q

when would you decrease infusion flow rate

A

CHF
Kidney disease
elderly patient

63
Q

permissive HoTN

A

theory that you leave some HoTN to prevent hypercoaguability and allow for stronger clot formation at a lower BP

64
Q

main takeaway of TRICC trial

A

do NOT transfuse someone based on H and H values

instead transfuse based on those who NEED

SU-18 ER (11 decks)

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