Fluids, electrolytes, and acid-base 5 Flashcards

1
Q

Which area of the Starling curve BEST correlates with preload dependence?
a. ascending limb
b. plateau
c. descending limb
d. unable to determine

A

a. ascending limb

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2
Q

Traditional fluid management consists of four components:

A

fluid maintenance
replacing the fluid deficit
replacing “third space” loss
replacing blood loss

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3
Q

What rule can be used to calculate maintenance fluids

A

4:2:1

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4
Q

________________ attempts to optimize the patient’s position on the Starling curve, where optimizing oxygen delivery is the fundamental objective.

A

Goal-directed fluid therapy

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5
Q

A key principle of goal-directed fluid therapy is the administration of

A

small quantities of fluid (~200-250 mL) to determine the difference between preload dependence and preload independence

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6
Q

Very minimal surgical trauma should be replaced with

A

1-2 mL/kg/hr

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7
Q

Minimal surgical trauma should be replaced with

A

2-4 mL/kg/hr (ex. inguinal hernia repair)

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8
Q

Moderate surgical trauma should be replaced with

A

4-6 mL/kg/hr (ex. major nonabdominal surgery)

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9
Q

Severe surgical trauma should be replaced with

A

6-8 mL/kg/hr (ex. major abdominal surgery)

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10
Q

Why is urine no longer a reliable measure of fluid status?

A

ADH reduces the kidney’s ability to eliminate fluid

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11
Q

The plateau of the Starling curve is known as

A

Preload independence; because there is an optimal balance between circulating volume & myocardial performance

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12
Q

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

A

c. carbohydrate drink two hours before surgery
d. avoidance of premedication

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13
Q

The primary objective of ERAS is to enhance postsurgical outcomes, which is accomplished through techniques that

A

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

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14
Q

Preoperative ERAS suggestions include

A

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

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15
Q

Intraoperative ERAS suggestion include

A

mid-thoracic epidural anesthesia
select short-acting drugs
goal-directed fluid therapy
normothermia
PONV prophylaxis
not using surgical drains

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16
Q

Postoperative ERAS suggestions include

A

mid-thoracic epidural anesthesia
opioid-sparing analgesia
judicious fluid administration
PONV prophylaxis
not using NGT/OGT
encouraging gut motility
early oral intake
early ambulation
early removal of urinary catheter