Fluids/Blood

Question 1

what’s Na content of 5% OR 25% albumin?

Answer 1

154 mEq/L

Question 2

what’s an alternative to normally-mixed Albumin?

Answer 2

mixed with D5W instead of NS

Question 3

What is total body fluid for men?
Women?
(Liters & percent)

Answer 3

men - 60% lean body weight
(.6*kg) = L; ~45 L

Women - 50% lean body weight
(.5*kg) = L; ~ 30 L

Question 4

Volume of blood in males/females?

Answer 4

M - 66mL/Kg ~ 5L

F - 60mL/Kg ~ 3.6L

Question 5

What percent of blood is plasma vs red cells?

Answer 5

40% - RBC

60% - plasma

Question 6

How much of TOTAL body fluid is extra cellular?

Answer 6

40%

Question 7

What two compartments make up extra cellular fluid? (Extracell fluid=40%)

Answer 7

ExtraVascular (interstitial)

IntraVascular (plasma)

Question 8

Plasma relates to interstitial fluid volume how?

Answer 8

Plasma vol is 25% of the amount of interstitial vol

3L vs 12L

Question 9

WHAT aspect of fluid we give creates an equilibrium problem?

- in what space?

Answer 9

SODIUM equilibrates throughout EXTRACELLULAR fluid (extracellular is 40% of total body fluid):

• extracellular = 25% plasma (intravasc) plus 75% (interstitial)
  3: 1……. interstitial fluid:intravasc fluid

Question 10

Two COMPENSATORY responses to acute blood loss?

Answer 10

1) interstitial fluid drain to capillaries/blood (+1L max to plasma)
2) RAS response - increase sodium conservation by kidneys

Question 11

RAS response primarily enhances volume for where?

Answer 11

Interstitial volume

Question 12

How many classes of blood loss are there?

Answer 12

4

Question 13

Class 1 blood loss….how much?

How compensate?

Question 14

Class2 blood loss amount?
How compensate?
findings?

Answer 14

15-30% blood loss

• systemic vasoconstrictor response
• SEE = postural changes in pulse rate and BP

Question 15

Where is vasoconstrictor response MOST intense in class 2 blood loss?
-consequences of that?

Answer 15

• splanchnic circulation

- –splanchnic hypoperfusion can lead to disruption of intestinal mucosa

Question 16

Class III blood loss volume?

-otherwise known as?

Answer 16

30-45%

-aka hemorrhagic SHOCK

Question 17

Clinical consequences of class III blood loss

Answer 17

Supine hypotension, impaired organ perfusion, anaerobic metabolism

Question 18

Evidence of impaired organ perfusion by?

Answer 18

Cool extremities, oliguria, depressed consciousness

Question 19

Class IV blood loss amount?

Answer 19

Greater than 45% of blood volume

Question 20

Clinical manifestations of class IV blood loss?

Answer 20

• multi organ failure

- severe metabolic acidosis

Question 21

What is MOST SENSITIVE and SPECIFIC physical sign of severe blood loss (630-1150mL)?

Answer 21

97%/98%
POSTURAL PULSE increment
(⬆ >️30 HR)

Question 22

Two ways of measuring cardiac filling pressures? (Old school)

Answer 22

• CVP

- pulm artery occlusion pressure

Question 23

why should CVP NOT be used to make decisions regarding fluid management?

Answer 23

Consistent lack of correlation btwn CVP and blood volume

Question 24

what is pattern of O2 use/ transport with hemorrhage or hypovolemia?

Answer 24

• DECREASE in systemic O2 delivery

- INCREASE in O2 extraction

Question 25

Hypovolemic shock, what is VO2’s result?

Answer 25

(VO2 = consumption of O2)
Abnormally low!!
–> hard to measure these parameters in acute hemorrhage

Question 26

When do you first see DYSOXIA?

Answer 26

With hemorrhagic shock (30% blood vol loss)

• enhanced glycolysis
• elevated lactate

Question 27

Active hemorrhage monitored via what 2 means?

Answer 27

1) serum lactate

2) arterial base deficit

Question 28

Which marker of tissue oxygenation was found to be SUPERIOR in predicting outcomes followed after ICU admission?

Answer 28

• LACTATE > Base deficit

- both equally predictive on admission, however

Question 29

Normal arterial base deficit?

Question 30

classify mild arterial base deficit

Answer 30

2-5 mmol/L

Question 31

Moderate arterial base deficit

Answer 31

6-14 mmol/L

Question 32

Severe base deficit

Answer 32

> 15

Question 33

Threshold for life-threatening lactate vs elevated lactate?

Answer 33

• elevated >2

- life-threatening >4

Question 34

End point of resuscitation for hemorrhagic shock?

Answer 34

Normalization of lactate levels within 24 hrs

Question 35

Recommended method for evaluating fluid responsiveness?

Answer 35

Fluid challenge (bolus)

Question 36

Fluid challenge favored in clinical studies?

Answer 36

500mL of isotonic saline infused over 10-15min

Question 37

Alternative fluid challenge? How work?

Answer 37

Passive leg raise.

• 150-750mL dumped into circulation
• 10-15% increase in aortic blood flow rate predicts fluid responsiveness - 90% sens, 90%specif

Question 38

What is limitation of leg-raising as alternative fluid challenge?

Answer 38

Increased intra-abdominal pressure

Question 39

Name of equation that relates FLOW of catheter to its radius and length?

Answer 39

Hagen-Poiseuille

Question 40

How is radius of catheter related to flow?

Answer 40

Flow is directly related to 4th power of inner radius

Question 41

How is length of catheter related to its flow?

Answer 41

Inversely proportional; longer catheter, less flow

Question 42

Viscosity of fluid related to flow thru catheter?

Answer 42

Viscosity of fluid Indirectly related to its flow

Question 43

Packed RED BLOOD CELLS has Hct of?

Answer 43

55%-60%

Question 44

First priority in bleeding patient?

Answer 44

Support cardiac output

Question 45

Estimating resusc volume?

Answer 45

1) est wnl blood vol (66ml/kg)
2) est % blood vol LOST
3) lost vol * Bl vol = deficit
4) deficit * 0.6 = Plasm vol def
5) 1/4 colloids; 3/4 crystalloids

Question 46

Penetrating trauma resuscitation?

Answer 46

Permitting low BP until BLEEDING CONTROLLED

Question 47

What is ratio of blood product resuscitation?

-monitoring goals

Answer 47

6units PRBCs: 1unit FFP
BUT…..
trauma: 1-2units PRBC: 1FFP

–keep INR 50K