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2 Review Course > Fluids and Blood > Flashcards

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
Q

What are the x and y axis on a Frank-Starling curve?

A

x: LVEDV, y: pressure (SV)

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26
Q

What are the segments of the Frank-Starling curve?

A

Ascending: preload dependence. Plateau: preload independence

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27
Q

The patient is considered fluid responsive if their pulse pressure variation is greater than what values?

A

13-15%

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28
Q

What are the 3 main goals of ERAS protocols?

A

decrease postop complications, accelerate recovery , and promote early mobilization and discharge

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29
Q

What are the four fluid replacement indices for ERAS protocols?

A

NPO deficit, maintenance requirement, 3rd space loss, EBL

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30
Q

What are the most abundant electrolytes in the ECV?

A

Na, and Cl

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31
Q

What is the most important osmotically active substance that influences water content in the brain?

A

Sodium

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32
Q

What are two causes of hyponatremia from an excess of water and not loss of sodium?

A

water intoxication and SIADH

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33
Q

What are manifestations of hyponatremia?

A

Nausea and vomiting, Cramps, Weakness, Agitation, Confusion, Headache, Anorexia, Cerebral edema, Seizures, Coma

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34
Q

What is one of the most significant complications of hyponatremia?

A

cerebral edema

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35
Q

What is the most common electrolyte abnormality in hospitalized patients?

A

hyponatremia

36
Q

What medications treat hypervolemic or euvolemic hyponatremia that is caused by CHF, cirrhosis, and polycystic kidney disease?

A

-vaptans Tolvaptan and conivaptan

37
Q

What are initial treatments of hyponatremia?

A

fluid restriction and diuresis

38
Q

What does rapid correction of hyponatremia cause?

A

myelinolysis

39
Q

Correction of serum sodium should not exceed that value in 24 hours?

A

10-15mmol/L

40
Q

What is usually the cause of hypernatremia?

A

impaired water intake

41
Q

What are manifestations of hypernatremia?

A

Thirst, Weakness, Seizure, Coma, Intracranial bleeding, Disorientation, Hallucinations, Irritability, Muscle twitching, Cerebral edema, polyuria or oliguria, renal insufficiency

42
Q

What are symptoms of potassium levels less than 2.5 mEq/L

A

paresthesia, depressed deep tendon reflexes, fasciculations, muscle weakness, and altered level of consciousness.

43
Q

What EKG changes are noted with hypokalemia?

A

ST depression, flat T wave, U waves

44
Q

What potassium levels are consistent with increased 30 day mortality and adverse cardiovascular events?

A

> 5.5 and < 4.0

45
Q

How do ACEI and ARBs affect potassium and sodium levels?

A

hyponatremia and hyperkalemia

46
Q

What is the treatment of hyperkalemia with no EKG changes?

A

give K binding resins in the GI tract, Lasix 40mg

47
Q

What is the treatment for hyperkalemia with peaked T waves?

A

Insulin/D50, hemodialysis

48
Q

What is the treatment for hyperkalemia with loss of P waves and wide QRS?

A

10mL of 10% Calcium chloride, NaHCO3 50-100mEq

49
Q

The majority of circulating calcium is found in what form?

A

ionized

50
Q

What are the most likely causes of hypocalcemia intraop?

A

hyperventilation and massive transfusion

51
Q

What are symptoms of hypocalcemia?

A

paresthesias, muscle weakness, tetany, Chvostek, trousseau’s, hyperreflexia, bradycardia, HoTN, laryngospasm, anxiety, irritability, confusion

52
Q

What are the most common causes of Hypercalcemia?

A

Hyperparathyroidism, malignancy

53
Q

What is the treatment of Hypercalcemia?

A

Fluids, and loop diretics

54
Q

What are symptoms of hypercalcemia?

A

Fatigue, weakness, Confusion, lethargy, Seizures, Coma, diminished deep tendon reflexes, HTN, AV block, Polyuria, polydipsia, Dehydration, Nausea, vomiting

55
Q

Hypomagnesmia can affect which phase of the cardiac action potential?

A

phase 4

56
Q

Alcoholics typically have what electrolyte derangement?

A

hypomagnesemia

57
Q

Hypermagnesmia can result from the treatment of what condition?

A

preeclampsia, preterm labor, ischemic heart disease, and cardiac dysrhythmias.

58
Q

What medication is an antagonist in the treatment of hypermagnesmia?

A

calcium chloride

59
Q

What is the estimated volume of a fully soaked surgical sponge and fully soaked laparotomy sponge?

A

Surgical: 10mL. Laparotomy: 100-150

60
Q

What is a preoperative autologous donation?

A

Patient donates this own blood to be given at a upcomjng surgery if needed. Up to 3 units!

61
Q

What are the benefits of preop autologous donation?

A

Reduced risk of acquired bacterimic, hemolytic, allergenic, antigenic, and graft vs host disease.

62
Q

What are the two benefits of acute normovolemic hemodilution?

A

Blood lost during surgery will have a decreased Hct and total blood loss is reduced.

63
Q

What three situations would define massive transfusion?

A

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
Q

What is the blood product of choice to improve CaO2?

A

RBC

65
Q

What is the ratio of RBC replacement to EBL?

A

1mL PRBC for every 2mL of blood loss

66
Q

What is the recommended dose of PRBC for pediatrics?

A

10-15mL/kg

67
Q

Thawed FFP has reduced levels of which coagulation factors?

A

V and VIII

68
Q

What are the dose of FFP?

A

5 to 8 mL/kg for reversal of warfarin, and 10 to 20 mL/kg for all other purposes

69
Q

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?

A

2.0

70
Q

What is the most common cause of transfusion related deaths?

A

TRALI

71
Q

What are the most common outcomes of graft vs host disease?

A

Rash, leukopenia, and thrombocytopenia

72
Q

What substance in the subendothelium facilitates anchoring of fibrin for the hemostatic plug?

A

Fibronectin

73
Q

Which blood vessel layer controls blood flow by altering degrees of contraction?

A

Adventitia

74
Q

What two substances produced by the endothelium cause vasodilation?

A

Nitric oxide and prostacyclin

75
Q

What are the three stages of platelet plug formation?

A

Adhesion, activation, aggregation

76
Q

What is the purpose of Gp1b?

A

Attach to vWF and attract platelets to the site of injury

77
Q

What inhibits the amount of factor 7 that becomes activated?

A

Tissue factor pathway inhibitor

78
Q

What is the other name for the intrinsic pathway?

A

Contact activation pathway

79
Q

What are the vitamin k dependent factors?

A

2,7,9,10

80
Q

What coagulation factors does protein c and s inhibit?

A

3,5,8

81
Q

What is the most commonly used test to monitor oral anticoagulation?

A

PT

82
Q

A deficiency in what two coagulation factors will definetly cause bleeing with injury?

A

Factors 8,9. “Hemophilia”

83
Q

What factors does cryo contain?

A

Factor 8, 13, fibrinogen and fibronectin

84
Q

What is the dose of factor 7 concentrate?

A

90-120mcg/kg

85
Q

What two physiologic parameters interrupt the efficacy of factor 7 concentrate?

A

Acidosis and hypothermia

2 Review Course (9 decks)

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