Fluids

Question 1

Replacing Evaporative Loss
(Via extent of surgery):

Min
Moderate
Severe
Emergency

Answer 1

Minimal (short/superficial surgery)
0-2 ml/kg/hr

Moderate (uncomplicated intra-ab)
3-5 ml/kg/hr

Severe (prolonged highly invasive)
6-9 ml/kg/hr

Emergency(multiple injuries, gun shot, MVA)
10-15 ml/kg/hr

Question 2

Blood Loss Replacement

Answer 2

3:1 (3cc crystalloid for 1 cc blood loss)

Replace 1:1 blood to colloid

Question 3

Allowable Blood Loss

Answer 3

EBV X (pt Hct - allowable Hct)
/
Pt Hct

Question 4

Evaporative Loss

Answer 4

R/t directly to SA of wound and duration of exposure

Question 5

Estimated blood Volune

Answer 5

Neonates

• premature 95ml/kg
• Term 85ml/kg

Infants 80 ml/kg

Child 70ml/kg

Adults
Men 75 ml/kg, Women 65ml/kg

Question 6

Floor Blood Loss estimation

Answer 6

4in = 80ml, 3in = 45ml, 2in = 20ml

Question 7

endothelial glycocalyx

Answer 7

gel layer in capillary epithelium
binds albumin
preserve oncotic P
< Cap permeability

Question 8

Assess Fluid Vol Status

Answer 8

lung sounds, VS
UO, Hct, BUN/Creatinine
ABG, urine specific gravity
skin turgor, m membranes edema

Question 9

Base Excess/ Deficit

Answer 9

0= normal bicarbonate level
-2 to <0 = met acidosis
>0 - +2 = met alkalosis

Question 10

Crystalloid:

Hypotonic Solution

Answer 10

replace water loss
“Maintenance fluid”
-have glucose
[D5W]

Question 11

Crystalloid

Isotonic Solutions

Answer 11

replace water and electrolyte loss
“replacement fluids”
[LR, NS]

Question 12

Crystalloid

Hypertonic Solution

Answer 12

use for hyponatremia or shock

[D5 1/2NS, 3% NS]

Question 13

LR

Answer 13

Na, K, Cl, Ca, lactate
isotonic (100ml free water/L)
will  bicarb
avoid in ESRD
No mixing w/ blood

Question 14

.9 NaCl Solution

Normal Saline

Answer 14

Na, Cl
Isotonic Solution
>Vol –> >Cl –>
hypercholeremic acidosis

Question 15

Plasmalyte-A, Normosol-R, Isolyte-S

Answer 15

Na, K, Cl, Phos, Mg, Acetate, gluconate

(2 Buffers)

Question 16

D5W

Answer 16

hypotonic
–> free water intoxication and hyponatremia
~200 calories/ 1L

Question 17

3% or 5% NaCl

Answer 17

Hypertonic
Na and Cl
Tx hyonatremia
SE: hyperchloremia, hypernatremia, cell dehydration

Question 18

Cryoprecipitate

Answer 18

Contain: Factor VIII, fibrinogen, vWf, XIII
Tx: Willebrand disease, fibrinogen deficiency (massive transfusions)
ABO compatile

Question 19

Platelets

Answer 19

USES: thrombocytopenia, dysfx plt, active bleeding, plt <50
Vol = 200-400
1 unit = > plt 7-10 (1hr post trfx)
SE: sepsis, bacterial contamination

Question 20

Fresh Frozen Plasma

Answer 20

Clotting factors and plasma proteins
Vol: 200-250ml
Must be ABO compatible
USES: warfarin reversal, coagulation factor deficiencies, microvascular bleeding (w/ > PT or PTT)
1 unit = > clotting factor by 2-3%

Question 21

Cell Saver CI

Answer 21

surgical wound contaminated with: 
bacteria
Amniotic fluid
malignant cells
chemical contaminants
(or pt w/ sepsis)

Question 22

Complications of autologous blood trfx

Answer 22

anemia
pre-op MI from anemia
wrong unit given
need for more frequent blood trfxn
febrile/ allergic rxn

Question 23

Packed RBC

Answer 23

USE: > O2 carrying capacity
Type specific ABO and Rh factor 
may need to further test for Ab
1 unit = > hgb 1
SE: citrate toxicity
   --> hypocalcemia (ical)

Question 24

Risks of blood product transfusion:

Answer 24

Hep B or C
HIV
Bacterial Sepsis
Allergic Rx/ Febrile rx
Lung injury
Hemolytic Rx
Non-cardiogenic pulm edema
Acute hypotensive transfusion rxn