Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergency Medicine > fluids > Flashcards

fluids Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

ii. The normal osmolarity of serum is about

A

290

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

iii. At any temperature above absolute zero, electrolytes will

A

diffuse throughout a solution to achieve uniform osmolarity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

iv. In biological systems, fluid compartments

A

(e.g., the extracellular and intracellular compartments) are separated from each other by semi-permeable membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

If you have two solutions of different concentrations that are separated by a semi-permeable membrane, the tendency of those solutions to equalize their concentration by moving water across the membrane is called the _________

A

osmotic pressure gradient.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

vi. The movement of water is called

A

osmosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

vii. The effect osmolarity has on this process is called

A

tonicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

_________are fluids that are close to the normal serum osmolarity of 290 mOsm/L.

A

a. Isotonic fluids are

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

_______fluids are fluids that have a lower osmolarity than serum.

A

b. Hypotonic fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

_______are fluids that have a higher osmolarity than serum.

A

Hypertonic fluids are fluids that have a higher osmolarity than serum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

small solutes; can move a little freely with this type of fluid

A

crystalloid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

big solutes; like blood wit this type of fluid

A

colloid
protein
plasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

nml Na

A

a. Normal value: between 135-145 mEq/L.

Critical for fluid balance, nerve function, muscle function.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

c. The #1 extracellular electrolyte.

A

Na

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

hypotonic crystalloid

A

D5W

of 1/2 NS (.45%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Because sodium is so closely linked to serum osmolarity, sodium derangement leads to changes of the body’s osmotic pressure gradient.

This causes cells to ______ in hyponatremia

or ______ in hypernatermia

this phenomena is worse here

A

cells to swell (in hyponatremia), or to shrink (in hypernatremia).

g. While this phenomenon affects all cells, it has an outsized effect on brain cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

hyponatremia is defined as

this is usually due to

A

Hyponatremia (Na <135)

May not see clinical signs until Na+ is <125.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

sxs of hyponatermia

A

Symptoms include lethargy disorientation, muscle cramps, anorexia, hiccups, nausea/vomiting, seizures.

Patient may have weakness, agitation, stupor, hyperreflexia, orthostatic hypotension, delirium, coma, death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Extrarenal losses

A

losing fluids faster than they can replenish it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Treatment of hyponatermia is to

A

correct the water overload (or deficit) and/or raise the sodium. (hypertonic sollution 3%)

vii. Find the underlying cause.
viii. Fluid restriction and monitoring.
ix. May give hypertonic saline for severe symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Careful of rapid correction of hyponatremia because

A

Careful of rapid correction—can cause central pontine myelinolysis (i.e., brain damage).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

list the colloids

A 
blood
albumin
dextran
FFP 
PRBCs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

dextran

A

glucose polysaccharide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

hypernatremia is defined as and caused by

A

i. Hypernatremia (Na >145)

(1) inadequate fluid intake;
(2) excess water loss;
(3) iatrogenic (in the hospitalized patient).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

FFP needed for

A

pts that would be bleeding a lot

coagulants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

PRBC

A

trauma -usually whole blood but not always

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

how to make decisions about fluids

A

do you need to make a decision right away

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

unstable pt start with

A

2 L NS

responder or non responder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

10% of body weight loss in an adult is what stage of dehydration

A

severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

mild and moderate dehydration looks like

A

6%

8%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

replenishing fluids in a pt with CHF or renal failure

A

really need to be slow with fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

maintenance fluids

what’s normal

A

unlike resuscitation you’re not trying to make up for significant loss
usually NPO

100-150mL an hour

small lil lady 90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

70Kg adult looses

A

2500-3000 mL/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

4-2-1 for children

A

4mL up to 10Kg
2Ml for next 10Kg
1mL per Kg after that

or broselow tape with weight and height

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

27 yo women in 1st trimester has been vomiting for 3 days

BP 90/60 HR 120 skin turgur decreased

what do we start with

A

need to know stable of unstable
this woman is severely dehydrated but unstable

10-15 mL/kg bolus
around 1 L
given antiemetics

after a second L of NS–> peeing

too much NS can lead to acidosis

35
Q

Parkland Formula

A

burn formula
exposed tissue come with incredible amounts of bluid loss

4ml x % body surface area burned x weight for the first 8 hrs

give 1/2 fluid at 8 hrs and then 1/2 that at 16

36
Q

non focal LOC

A

infection-meningitis, encephalitis

trauma

seizure

CVA

overdose

metabolic- hypoglycemia or hyponatremia

alcohol

37
Q

when you have someone with hyponatremia you need to

A

this is the neuro electrolyte
will shrink or swell brain cells

check a glucose

38
Q

ADH effects of osmolarity

A

CONSERVES WATER
hormonal control of Na

too much ADH can lead to water intoxication

39
Q

aldosterone effects on osmolarity

A

conserves SODIUM and too much leads to K loss and Na retention

40
Q

pseudohyponatremia is due to

A

high concentrations of glucose lipids or proteins in the plasma

makes the water want to leave the cells and rush into extracellular space making it look lik ehyponatremia

water is drawn out and into plasma

41
Q

each 100 mg/dL glucose elevation decreases the Na by

A

1.6- 1.8 mEq/L

42
Q

treatment of pseudohyponatremia

A

manage the underlying cause

consider volume status and serum osmoles

43
Q

sxs of hypervolemic hyponatremia

A

confusion HA vomiting seizures coma and death

44
Q

hypervolemic hyponatremia Rx

A

if stable need to restrict water and weight

is seizing or coma would consider using hypertonic saline

45
Q

hypovolemic and hyponatermia tx

A

seen with decreased extracellular fluid

rx volume replacement with NS

46
Q

central pontine myelinolysis

what is the general rule to help avoid this

A

looks like pig on CT

too rapid correction of hypovolemic hyponatremia

Na that causes shrinkage fo the brain cells and leads to damage

in general better to correct no faster than it occured

(in chronic pts no more than .5 mEq/hour)

47
Q

older woman LOC
Na=164
BUN=55
Cr=2.5

A

dehydration and hypernatremia

too little water or no ADH can lead to this as does sweating hyperventilation

48
Q

hypernatremia sxs

A

when >155 -160 OR osm>350

Irritability restlessness
seizures
coma
permanent neuro damage

tx with NS or D5 1/2 NS

49
Q

44 yo man that missed 2 dialysis treatments

A

NEED EKG first

seen with peaked T waves

the kidneys aren’t filtering so the body is retaining potassium

50
Q

5.5 mEq/L: EKG changes

A

Peaked T-waves (repolarization abnormalities).

51
Q

> 6.5 mEq/L ekg changes

A

: P wave flattens, PR prolongation (paralysis of atria).

52
Q

> 7.0 mEq/L EKG

A

QRS prolongation, ventricular arrhythmias.

53
Q

> 9.0 mEq/L EKG

A

Cardiac arrest due to asystole, ventricular fibrillation, or PEA.

54
Q

three goals of treating hyperkalemia

A

➤ Protect the cardiac conduction system;

➤ Shift potassium from the extracellular fluid compartment back into the cells;

➤ Remove excess potassium from the body.

55
Q

what type of Ca do you give

A

calcium Chloride for Coding
needs to be given through a central line
need to avoid unless you’re in a situation that really calls for it
very caustic to the tissues

calcium Gluconate for any other time

56
Q

why do you give insulin

A

to move K into the cell

if their sugars are high

if they are normal given glucose and insulin

57
Q

other than insulin what else moves Ca into the cell

A

ALBUTEROL

58
Q

Intravenous calcium is given in hyperkalemia in order to

A

Intravenous calcium to antagonize the membrane actions of hyperkalemia (see ‘Calcium’ below)

59
Q

hypokalemia looks like what on a EKG (4)

A

i. Flattened T waves
ii. Prolonged QT interval
iii. U waves
iv. Ventricular arrhythmias

muscle WEAKNESS

60
Q

Tx of hypokalemia

A

Not an emergency unless cardiac manifestations are present.

Replete potassium (50 mEq will raise serum K+ by 1.0)

Can give orally, which is safer but slower.

When giving IV, need to use a large vein (potassium is is very irritating)
v. Give up to 20 mEq/hr.

61
Q

what causes hypokalemia

A

i. Diuretics
ii. Vomiting
iii. Diarrhea

also
alkalosis
insulin
albuterol and beta adrenergic

62
Q

hypokalemia defined as

A

Defined as potassium less than 3.5 mEq/L

63
Q

other than excessive excretion what else can cause hypokalemia

A

b. Can be caused by potassium being shifted into the cells
i. Alkalosis
1. Insulin and glucose use

  1. Use of beta-2 agonists (e.g., albuterol).
64
Q

27yo woman presents to the ED with tingling around her mouth for two days. She also has some facial twitching.
ii. PMH: had thyroid surgery two weeks ago.

PE: Normal vitals.

LABS you want

A

Chem 7

TSH

CBC

But her calcium is 6.4 (normal is 8.5-10.5).

65
Q

normal Ca levels

A

8.5-10.5 CC looks like an 8

66
Q

Hypocalcemia Ca++ defined as

A

<8.5

67
Q

what’s more common hypo or hyper Ca

A

hypo more common than hypercalcemia.

68
Q

causes of hypo Ca

A

Most commonly results from a chronic disease, with chronic kidney disease being the most frequent cause.

  1. Hypoparathyroidism
  2. Acute pancreatitis
    - -> fatty sludge chelates to the Ca
  3. Alkalosis
  4. Massive blood transfusions
69
Q

EKG with hypoCa

A

prolonged QT interval that may progress to Torsades de Pointe.

70
Q

sxs of hypoCa

A
  1. Dry skin and brittle nails
  2. Muscle cramping
  3. Pruritus
  4. Shortness of breath
  5. Numbness and tingling
  6. Syncope, angina, heart failure
  7. Hyperreflexia, tetany, clonus
71
Q

Chvostek’s sign

A

Tap the patient’s face just in front of the ear. A positive Chvostek’s sign is when the patient’s lip twitches on the same side where you’re tapping.

72
Q

Trousseau’s sign

A

hyperca evaluation

Apply a blood pressure cuff, inflate it above the patient’s systolic blood pressure, and leave it on for 3-5 minutes.

A positive Trousseau’s sign is when the patient’s hand and forearm muscles go into spasm.

73
Q

TX of hypoCa

A
  1. ABCs
  2. Treat severe hypocalcemia with IV calcium gluconate or calcium chloride.
  3. Mild hypocalcemia can be treated outpatient with oral calcium replacement and Vitamin D supplements.
74
Q

Ca plays essential role in

A

Important in transmission of nerve impulses, muscle contraction, cardiac electrical conduction, and other things

75
Q

There are multiple complex interrelated mechanisms that contribute to serum calcium homeostasis. These involve

A 
Vitamin D levels
 the small intestine
 renal tubules
parathyroid hormone (PTH)
and bone.

The most direct of these mechanisms, is PTH. If PTH is high, then calcium is high and phosphorus is low. If PTH is low, then calcium is low and phosphorus is high.

76
Q

causes of hyperCa

A
  1. Elevated PTH
  2. Cancer with bony metastases
  3. Elevated Vitamin D
  4. Thiazides
  5. Sarcoidosis
  6. Many other possible causes….
77
Q

sxs of hyperCa

A

Stones, Bones, Groans, Moans, Thrones, and Psychiatric Overtones.”

  1. Nephrolithiasis
  2. Bone pain
  3. Lethargy and fatigue
  4. Abdominal pain
  5. Polyuria and polydipsia
  6. Confusion, depression, irritability, anxiety, hallucinations…
78
Q

tx of hyper Ca

A
  1. IV fluids
    a. Large amounts of isotonic crystalloid to restore volume.
  2. Increase calcium excretion with a loop diuretic (NOT a thiazide).
  3. Drugs that decrease the release of calcium from bone
    a.Calcitonin, mithramycin, corticosteroids,
    bisphosphonates
79
Q

not typically on a chem panel but need to order these if you suspect any electrolyte abnormalities

A

magnesium and phosphorus

80
Q

hypo phophorus sxs

A

muscle dysfunction
weakness
decreased cardiac output
confusion delirium

sxs usually occur with levels less than 2mg/dL

81
Q

treat hypophos

A

underlyinG
DKA/diarrhea anatacid
vit d

TX with oral repletion until level <1mg/dL then give IV

82
Q

hyperphosphorus

A

usually asymptomatic

secondary to laxatives/enemas renal failure
prolonged exercise

diet/phosphate binders if indicated

83
Q

what is a blous

A

however big the IV is will determine how fast the pt gets it when the line is wide open

ALWAYS think about this

the bolus is as fast as it will go in

you can say this but if you want to go slower you have to specify 150cc an hour is crazy slow (7 hours per liter)

Emergency Medicine (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions