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Fluids and Blood Flashcards

1
Q

Total body water represents that percentage of lean body mass?

A

60%

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2
Q

What is the primary cation and anion of the ECV?

A

Na+

Cl-

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3
Q

What is the primary cation and anion of the ICV?

A

K+

PO4-

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4
Q

What is the daily fluid volume required to maintain TBW homeostasis?

A

25-35mL/k per day (2-3 L)

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5
Q

Which of the four transcapillary pressures are is slightly negative?

A

Pif - interstitial fluid pressure. Due to lymphatic vessels.

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6
Q

What is the primary determinant of both capillary and interstitial oncotic pressure?

A

albumin

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7
Q

What transcapillary pressures favor filtration of fluid into the interstitial space?

A

capillary hydrostatic and interstitial oncotic.

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8
Q

What transcapillary pressure favor absorption of fluid into the intravascular space?

A

interstitial hydrostatic and capillary oncotic

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9
Q

What results from positive net filtration when discussing transcapillary pressures?

A

edema

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10
Q

What results from negative net filtration when discussing transcapillary pressures?

A

fluid absorption into the vasculature

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11
Q

The regulation of the ECV is largely dependent on which ion?

A

sodium

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12
Q

What are negative effects of hyperchloremia from large volumes of NS?

A

Decreased GFR, increased salt and water retention

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13
Q

Which patient population is NS most appropriate for?

A

Neurosurgical patients. (In small amounts, d/t slight hyperosmolarity reducing risk of cerebral edema)

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14
Q

Which patient populations is LR contraindicated in?

A

Diabetics, TBI, neurovascular insults

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15
Q

Which 3 fluids are considered the most isotonic of the balanced salt solutions?

A

Plasmalyte, normasol, isolyte

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16
Q

What are the buffers used in plasmalyte, normasol, and isolyte?

A

Sodium gluconate and sodium acetate

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17
Q

What starling force do colloids directly affect?

A

Increase Plasma oncotic

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18
Q

How does dextran affect coagulation? (3)

A

Impairs vWF, activates plasminogen, interferes with platelet aggregation

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19
Q

Hydroxylethyl starches are contraindicated in which patient population?

A

Allergies to starchy plants; potatoes, maize, sorghum

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20
Q

What did thr CREST study determine about hydroxylethyl starches?

A

Increase the risk of renal injury. (Black box warning)

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21
Q

What is the Donnan effect?

A

Becuase of albumins negative charge, it binds ions which increases plasma osmolarity and intravascular volume

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22
Q

What did the SAFE trial determine?

A

No difference in outcomes with albumin and NS. Except neurotrauma; albumin increased mortality.

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23
Q 
What are the guidelines for fluid replacement for 
 Superficial Trauma:
Minimal Trauma (herniorrhaphy): 
Moderate Trauma (major nonabd or laparoscopic abd. surgery): 
Severe Trauma (major open abd. surgery):
A 
Superficial Trauma (orofacial): 1–2 mL/kg per hr
Minimal Trauma (herniorrhaphy): 2–4 mL/kg per hr
Moderate Trauma (major nonabdor laparoscopic abd surgery): 4–6 mL/kg per hr 
Severe Trauma (major open abd surgery): 6–8 mL/kg per hr
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24
Q

What are unreliable methods of determining fluid responsiveness and volume status?

A

CVP, urine output,

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25
What are the x and y axis on a Frank-Starling curve?
x: LVEDV, y: pressure (SV)
26
What are the segments of the Frank-Starling curve?
Ascending: preload dependence. Plateau: preload independence
27
The patient is considered fluid responsive if their pulse pressure variation is greater than what values?
13-15%
28
What are the 3 main goals of ERAS protocols?
decrease postop complications, accelerate recovery , and promote early mobilization and discharge
29
What are the four fluid replacement indices for ERAS protocols?
NPO deficit, maintenance requirement, 3rd space loss, EBL
30
What are the most abundant electrolytes in the ECV?
Na, and Cl
31
What is the most important osmotically active substance that influences water content in the brain?
Sodium
32
What are two causes of hyponatremia from an excess of water and not loss of sodium?
water intoxication and SIADH
33
What are manifestations of hyponatremia?
Nausea and vomiting, Cramps, Weakness, Agitation, Confusion, Headache, Anorexia, Cerebral edema, Seizures, Coma
34
What is one of the most significant complications of hyponatremia?
cerebral edema
35
What is the most common electrolyte abnormality in hospitalized patients?
hyponatremia
36
What medications treat hypervolemic or euvolemic hyponatremia that is caused by CHF, cirrhosis, and polycystic kidney disease?
-vaptans Tolvaptan and conivaptan
37
What are initial treatments of hyponatremia?
fluid restriction and diuresis
38
What does rapid correction of hyponatremia cause?
myelinolysis
39
Correction of serum sodium should not exceed that value in 24 hours?
10-15mmol/L
40
What is usually the cause of hypernatremia?
impaired water intake
41
What are manifestations of hypernatremia?
Thirst, Weakness, Seizure, Coma, Intracranial bleeding, Disorientation, Hallucinations, Irritability, Muscle twitching, Cerebral edema, polyuria or oliguria, renal insufficiency
42
What are symptoms of potassium levels less than 2.5 mEq/L
paresthesia, depressed deep tendon reflexes, fasciculations, muscle weakness, and altered level of consciousness.
43
What EKG changes are noted with hypokalemia?
ST depression, flat T wave, U waves
44
What potassium levels are consistent with increased 30 day mortality and adverse cardiovascular events?
> 5.5 and < 4.0
45
How do ACEI and ARBs affect potassium and sodium levels?
hyponatremia and hyperkalemia
46
What is the treatment of hyperkalemia with no EKG changes?
give K binding resins in the GI tract, Lasix 40mg
47
What is the treatment for hyperkalemia with peaked T waves?
Insulin/D50, hemodialysis
48
What is the treatment for hyperkalemia with loss of P waves and wide QRS?
10mL of 10% Calcium chloride, NaHCO3 50-100mEq
49
The majority of circulating calcium is found in what form?
ionized
50
What are the most likely causes of hypocalcemia intraop?
hyperventilation and massive transfusion
51
What are symptoms of hypocalcemia?
paresthesias, muscle weakness, tetany, Chvostek, trousseau's, hyperreflexia, bradycardia, HoTN, laryngospasm, anxiety, irritability, confusion
52
What are the most common causes of Hypercalcemia?
Hyperparathyroidism, malignancy
53
What is the treatment of Hypercalcemia?
Fluids, and loop diretics
54
What are symptoms of hypercalcemia?
Fatigue, weakness, Confusion, lethargy, Seizures, Coma, diminished deep tendon reflexes, HTN, AV block, Polyuria, polydipsia, Dehydration, Nausea, vomiting
55
Hypomagnesmia can affect which phase of the cardiac action potential?
phase 4
56
Alcoholics typically have what electrolyte derangement?
hypomagnesemia
57
Hypermagnesmia can result from the treatment of what condition?
preeclampsia, preterm labor, ischemic heart disease, and cardiac dysrhythmias.
58
What medication is an antagonist in the treatment of hypermagnesmia?
calcium chloride
59
What is the estimated volume of a fully soaked surgical sponge and fully soaked laparotomy sponge?
Surgical: 10mL. Laparotomy: 100-150
60
What is a preoperative autologous donation?
Patient donates this own blood to be given at a upcomjng surgery if needed. Up to 3 units!
61
What are the benefits of preop autologous donation?
Reduced risk of acquired bacterimic, hemolytic, allergenic, antigenic, and graft vs host disease.
62
What are the two benefits of acute normovolemic hemodilution?
Blood lost during surgery will have a decreased Hct and total blood loss is reduced.
63
What three situations would define massive transfusion?
10 units of RBCs in 24 hours, or loss of one blood volume in a 70 kg patient, 4 units PRBC's in one hour with hemodynamic instability
64
What is the blood product of choice to improve CaO2?
RBC
65
What is the ratio of RBC replacement to EBL?
1mL PRBC for every 2mL of blood loss
66
What is the recommended dose of PRBC for pediatrics?
10-15mL/kg
67
Thawed FFP has reduced levels of which coagulation factors?
V and VIII
68
What are the dose of FFP?
5 to 8 mL/kg for reversal of warfarin, and 10 to 20 mL/kg for all other purposes
69
FFP is discouraged if the INR is less than what value in the absence of active bleeding, and the use of Vitamin K is encouraged if the patient is on warfarin?
2.0
70
What is the most common cause of transfusion related deaths?
TRALI
71
What are the most common outcomes of graft vs host disease?
Rash, leukopenia, and thrombocytopenia
72
What substance in the subendothelium facilitates anchoring of fibrin for the hemostatic plug?
Fibronectin
73
Which blood vessel layer controls blood flow by altering degrees of contraction?
Adventitia
74
What two substances produced by the endothelium cause vasodilation?
Nitric oxide and prostacyclin
75
What are the three stages of platelet plug formation?
Adhesion, activation, aggregation
76
What is the purpose of Gp1b?
Attach to vWF and attract platelets to the site of injury
77
What inhibits the amount of factor 7 that becomes activated?
Tissue factor pathway inhibitor
78
What is the other name for the intrinsic pathway?
Contact activation pathway
79
What are the vitamin k dependent factors?
2,7,9,10
80
What coagulation factors does protein c and s inhibit?
3,5,8
81
What is the most commonly used test to monitor oral anticoagulation?
PT
82
A deficiency in what two coagulation factors will definetly cause bleeing with injury?
Factors 8,9. “Hemophilia”
83
What factors does cryo contain?
Factor 8, 13, fibrinogen and fibronectin
84
What is the dose of factor 7 concentrate?
90-120mcg/kg
85
What two physiologic parameters interrupt the efficacy of factor 7 concentrate?
Acidosis and hypothermia

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