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Anaesthesiology > Fluids And Blood > Flashcards

Fluids And Blood Flashcards

1
Q

What is the blood volume of an adult?

A

70 ml per kg men lean body mass
65 women and elderly men

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2
Q

What is the blood volume of a neonate?

A

90 ml / kg lean body mass

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3
Q

Formula for volume of packed red cell needed?

A

PRBC = IBV x change in Hct/70 ml

1,5x weight x (hct2-hct1)

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4
Q

maintenance fluid dose for adults?

A

1-2 ml/kg/h

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5
Q

What is maintenance fluid?

A

Compensate for normal fluid losses eg respiration, skin, urine, bowel losses

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6
Q

Which fluid should be used for replacement upper git losses?

A

Losses rich in chloride, hydrogen and potassium so give normal saline with potassium

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7
Q

Which fluid should be used for replacement lower git losses?

A

Losses rich in bicarbonate so replace with normal saline with potassium and bicarb

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8
Q

Replacement fluid dose for burns patients?

A

Parkland formula Ringers
4 ml /% burns/kg/h
Half replacement in 8 hours, other half in 16 hours.

If NPO, maintenance x hours NPO and give 50% during first hour.

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9
Q

When should blood transfusion be done?

A

If > 20% blood loss

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10
Q

Oxygen flush formula?

A

Do2= co x caCo2
= co x (hb x 1,34 x Sao2 + 0,031 x pa02)

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11
Q

Formula for ASI and interpretation?

A

Awake shock index = pulse ÷ SBP
Normal = 0,4-0,7,
If 1 or more, will need blood transfusion due to severe shock

0,8-1= 10-20 % blood loss
1-1,5= 20-33%
1,5-2 = 33 -50%
> 2=50%.

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12
Q

Name the 7 end points of resuscitation

A

• Map >65 mm hg
• urine output > 0,5 ml/kg / h
• SVO2 > 70% (central venous oxygen saturation)
• CVP 8-12 cm H2O
• transfuse up to haematocrit of 30
• look at improvement ph, lactate

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13
Q

Blood volume of premature baby (<37 weeks birth)

A

95 ml/kg

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14
Q

Blood volume of infant ( 6 weeks - 12 months)?

A

80 ml / kg

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15
Q

Blood volume of child ( 1 to 12 years)?

A

70 ml / kg

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16
Q

Name the 2 groups of fluids with examples

A

Crystalloid’s
• isotonic: ringer’s lactate, normal saline
• hypertonic: dextrose solutions eg dextrose 5%

Colloids (starling equation)
• natural: albumin 5% and 25%, FFP
• synthetic: dextrans, gelatins (gelofusin), hydroxy-ethylstarches (voluven)

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17
Q

Compositions of normal saline? (11) NB

A

• Sodium 154 ( more than plasma)
• No potassium
• No magnesium
• No calcium
• chloride 154 ( more than plasma)
• no phosphorous
• no lactate
• no bicarb
• No glucose
• ph 5,5 (acidic, more so than Ringer’s)
• osmolarity 308 ( isotonic )

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18
Q

Composition of ringer’s lactate? (11) NB

A

• Sodium 131 ( less than plasma)
•potassium 5 (same as plasma)
• No magnesium
•calcium 1,8 ( less than plasma)
• chloride 112 ( more than plasma)
• no phosphorous
•lactate 29
• no bicarb
• No glucose
• ph 6,5 (acidic)
• osmolarity 279 ( isotonic )

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19
Q

Composition of plasmalyte B? (11) not nb

A

• Sodium 131 ( less than plasma)
•potassium 5 (same as plasma)
•magnesium 3 ( double plasma)
•No calcium
• chloride 112 ( more than plasma)
• no phosphorous
•no lactate
•bicarb 28 (same as plasma)
• No glucose
• ph 7,4 (normal)
• osmolarity 273 ( isotonic )

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20
Q

Name 3 advantages of using crystalloids as resuscitation fluids

A

• Easily obtainable and cheap
• just as efficient as volume expander as colloid if given in sufficient amounts
• patients may be dehydrated intracellularly so benefit from fluids that move intracellularly

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21
Q

Name 3 disadvantages of using crystalloids as resuscitation fluids

A

• Short intravascular half life: within 2 hours of admin < 20% remains intravascular
• increased risk diffuse interstitial oedema
• may cause hypercoagulable
(Last 2 due to damage by crystalloids to glycoprotein lining of Endothelium, the glycocalyx, which maintains endothelial homeostasis. )

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22
Q

Which 2 resuscitation crystalloid contain magnesium?

A

Plasmalyte B and balsol

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23
Q

Which crystalloids contain calcium? (2)

A

Ringer lactate and neonatalyte

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24
Q

Which crystalloids contain bicarb? (3)

A

Plasmalyte B (28), balsol (28), naHco3 8.4% (1000)

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25
Q

Which crystalloids have lowest ph?

A

Maintelyte in glucose (4)

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26
Q

Which crystalloids have lowest osmolarity?

A

Plasmalyte B and balsol (273) - closest to blood

27
Q

Name 7 disadvantages and side effects of colloids

A

• Expensive
• anaphylaxis (especially gelatins)
• dilute red blood cells, platelets, clotting factors. Large volumes cause hypocoagulability by dilution thrombocytopenia (especially dextrans)
• fluid overload
• prolonged in renal failure
• pruritis
• increase incidence renal failure in septic patients

28
Q

Name advantages colloids (2)

A

• Replace blood loss 1:1
• intravascular half life longer at 3-6 hours

29
Q

Which fluid type is preferred for administration?

A

Start off with crystalloid
After 2 L , give colloid

30
Q

Define massive transfusion (4)

A

•>10 units blood in first 24h
• entire blood volume in 24h
• > 50% blood volume in 3 hours
• 3 units in 1 hour (about 10 units in body)

31
Q

What should Hb goal be in blood transfusion ?

A

6 g / dl in healthy patient
7 in associated disease
8 in acute coronary syndrome

32
Q

Dose tranexamic acid in patient that has lost > 20% blood volume?

A

1g stat

33
Q

What blood ratio should be given in blood transfusion?

A

1 blood: 1 plasma: 1 platelets

34
Q

Name 4 mechanisms blood conservation

A

• Cell saver
• autologous blood transfusion
• haemodilution
• antifibrinolytics

35
Q

When should platelets be prescribed?

A

Loss 1 blood volume

36
Q

Name 6 transfusion reactions

A

• Acute haemolytic reactions: Abo incompatibility
• delayed haemolytic reactions: Rh
• allergic reactions: incompatible proteins
• graft vs host reaction
. Febrile non-haemolytic reactions
. Post transfusion purpura

37
Q

Name 7 metabolic deviations and complications resulting from blood transfusion

A

• hyper k, hyper mg, hypo Ca (citrate in blood bind Ca)
• decreased ph
• decrease 2,3 dpg ( L shift oxy-Hb curve )
• ATP depletion
• release pro-inflammatory substances
• decrease platelets and clotting factor 5 and 8
• post-op infection if blood is old

38
Q

What is TRALI and pathophysiology? (4)

A

• Transfusion related acute lung injury.
• 1-6 h after transfusion
• Patient hypoxic, no signs pulmonary oedema, white lungs
. Caused by FFP

39
Q

Name 6 diverse reactions to blood transfusions

A

• Hypothermia
• citrate toxicity with decreased calcium
• fluid overload
• air embolism
• bacterial contamination
• bleeding tendency: dilution thrombocytopenia

40
Q

How does hyponatraemia present and what are some causes and treatment in hypo, Normo and hyper volaemia? Surgical implication?

A

• <135 mmol/l
• acute picture: lethargy, confusion, seizures, coma
• hypovolaemia: electrolyte rich fluid loss, nv, diarrhoea, fistulae, diuretics, cerebral salt wasting syndrome. Treat with normal saline
• normovolaMia: siadh, hypothyroid, Addison’s. Treat with HRT and fluid restriction
• hyper volaemia: TURP syndrome, cardiac failure (secondary hyperaldosteronism), renal failure, cirrhosis. Treat with fluid restriction and diuretics
pseudohyponatraemia
• if <130, postpone sx: increase risk cerebral oedema, delayed awakening
• <120 high mortality! Treat slowly to prevent pontine demyelination

41
Q

Fluid Resuscitation formula for bleeding adults?

A

Crystalloid: 3ml for every 1ml blood loss
Colloid:1ml for every 1ml blood loss

42
Q

Composition of maintelyte? (Na, K, Mg, Ca, Cl, P, lactate, bicarbonate, glucose, PH, osmolality) NB

A

Na: 35 (much less than plasma)
K: 25 (much more than plasma)
Mg: 2,5 (same as plasma)
Ca: none
Cl: 65 (much less than plasma)
P: none
Lactate: none
Bicarb: none
Glucose: 100 (10%) or 50 (5%)
PH: 4 (most acidic)
Osmolality: 10% 683; 5% 405 (hypertonic)

43
Q

Max dose of voluven per day?

A

45 ml/kg/day

44
Q

Where in the body is most of the water content found?

A

Intracellular fluid compartment

45
Q

What is the main electrolyte composition of extracellular fluid?

A

Sodium, chloride, bicarbonate

46
Q

What is the main electrolyte composition of intracellular fluid?

A

Potassium, magnesium, phosphate

47
Q

Name 2 indications voluven

A

• Good to replace acute and intra-op blood loss at ratio 1:1
• spinal to coload patient and expand intravascular volume- help with hypotension
Lowest risk anaphylaxis of all the colloids

48
Q

Name 3 indications colloids

A

• Fluid resus in patients with severe intravascular deficits prior to initiating blood products
• fluid resus in presence severe hypoalbuminaemia or large protein losses eg burns
• when crystalloid replacement exceeds 3-4 L

49
Q

Name 4 electrolytes found in volulyte

A

Sodium, potassium, chloride, magnesium, acetate

50
Q

Name 2 adverse effects voluven

A

• Excreted by kidneys: renal disfunction
. Coagulopathy in elderly

51
Q

Generic name voluven/volulyte/ venofundin?

A

Tetrastarch

52
Q

When would saline be chosen over ringers for maintenance?

A

• low sodium that needs replacement
• high potassium

53
Q

How decide when to transfuse

A

Look at hb (<10) and hct <30 but also clinical picture! And oxygen flush formula
= transfusion triggers

54
Q

Formula for ml of red cell concentrate to transfuse?

A

VTT= ebv x (initial hct- current hct )÷ 70 ml

55
Q

How are red cells concentrate stored?

A

Fridge at 4°c

56
Q

How are fresh frozen plasma stored?

A

Freezer at -30°c

57
Q

How are platelets stored?

A

At room temperature, kept agitated

58
Q

How are cryoprecipitate stored?

A

Freezer at -30°c

59
Q

NB name 7 transfusion triggers for platelets

A

• Massive blood loss with oozing in the surgical field
• massive transfusion
• trauma resuscitation with 1:1:1 ratio
• all surgical patients with absolute count <50
• neuro ophthalmic and hepatic surgery <100
• all other patients <10

Dose 10 ml/kg infants, 1 mega unit or 5ml/kg adults

60
Q

How do hct and hb relate?

A

Hct = hb x 3

61
Q

Name 5 types of blood products

A

• Whole blood
• red cell concentrate
• fresh frozen plasma (use for low clotting factors - all)
• platelets
• cryoprecipitate (clotting factors - only VIII, XIII, vWF)

62
Q

Name 6 changes in stored blood (NB)

A

• Decreased ph secondary to continued metabolism
• increased PCO2 and lactate
• increased potassium
• decreased 2,3 DPG - left shift oxy-hb dissociation curve
• platelets only viable 1 day
• decreased clotting factors. V and vIll

63
Q

Name 8 transfusion triggers for red cells

A

• All patients with hb ≤ 60 g / l (6g/dL)
•>80 years with hb ≤ 70
• CVD with hb ≤ 80
• increased vo2 (oxygen consumption: high temperature, high metabolism) with Hb ≤80
• infants with hb <90
• haemodynamic: relative tachycardia (>110-130 bpm from baseline) or relative hypotension (<55 from baseline in healthy, <70-80 in CVD and HT, higher severely HT)
• myocardial ischaemia: new ST segment depression > 0,1mv or elevation > 0,2mV; or Clinical signs confirmed with ECG and or troponin
• central venous oximetry 1 or more: pv02 <32 mmHg , scvp02 <50% , o2er > 50%, decrease vo2 > 10%

Anaesthesiology (24 decks)

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