Fluids, electrolytes, and acid-base 5 Flashcards
Which area of the Starling curve BEST correlates with preload dependence?
a. ascending limb
b. plateau
c. descending limb
d. unable to determine
a. ascending limb
Traditional fluid management consists of four components:
fluid maintenance
replacing the fluid deficit
replacing “third space” loss
replacing blood loss
What rule can be used to calculate maintenance fluids
4:2:1
________________ attempts to optimize the patient’s position on the Starling curve, where optimizing oxygen delivery is the fundamental objective.
Goal-directed fluid therapy
A key principle of goal-directed fluid therapy is the administration of
small quantities of fluid (~200-250 mL) to determine the difference between preload dependence and preload independence
Very minimal surgical trauma should be replaced with
1-2 mL/kg/hr
Minimal surgical trauma should be replaced with
2-4 mL/kg/hr (ex. inguinal hernia repair)
Moderate surgical trauma should be replaced with
4-6 mL/kg/hr (ex. major nonabdominal surgery)
Severe surgical trauma should be replaced with
6-8 mL/kg/hr (ex. major abdominal surgery)
Why is urine no longer a reliable measure of fluid status?
ADH reduces the kidney’s ability to eliminate fluid
The plateau of the Starling curve is known as
Preload independence; because there is an optimal balance between circulating volume & myocardial performance
Identify the components of the ERAS program that are believed to improve postsurgical outcomes (select 2).
a. isoflurane instead of desflurane
b. insertion of a nasogastric tube
c. carbohydrate drink two hours before surgery
d. avoidance of premedication
c. carbohydrate drink two hours before surgery
d. avoidance of premedication
The primary objective of ERAS is to enhance postsurgical outcomes, which is accomplished through techniques that
attenuate the physiologic changes that accompany surgical trauma
minimize the impact of fluid shifts
maximize the nutritional impact of healing
improve postoperative pain so patients can recover faster
improve patient education and compliance
Preoperative ERAS suggestions include
preadmission counseling
fluid & carbohydrate loading
fasting (2 hrs. fluids & 6 hrs. solids)
antibiotic prophylaxis
avoidance of premedication
no (or highly selective) use of bowel prep
thromboprophylaxis
Intraoperative ERAS suggestion include
mid-thoracic epidural anesthesia
select short-acting drugs
goal-directed fluid therapy
normothermia
PONV prophylaxis
not using surgical drains