Fluids, Hemstasis, Transfusion, Shock Flashcards
Remarks on hypocalcemia
Possible causes: -pancreatitis -hypoparathyroidism May cause: -decreased cardiac contractility -heart failure -prolonged QT -T wave inversion -heart block -ventricular fibrillation (not atrial fib)
ECG changes in hyperkalemia
Peaked T waves (early chage) Flattened P wave Prolonged PR (first degree block) Widened QRS Sine wave Ventricular fib
Remarks on albumin in fluid res
Available as 5% (osm of 300mOsm/L) or 25% (osm of 1500 mOsm/L)
May lead to pulmonary edema when used as resuscitation for hypovolemic shock
Remarks on TBW of neonatewts
Highest % of TBW found in newborns, with ~ 80% TBW composed of water. This decreases to about 65% by 1 year and thereafter remains fairly constant
Ho to correct potassium for alkalosis
Potassium decreases by 0.3mEq/L for every 0.1 increases in pH above normal
Water deficit
Water deficit (L) = [(serum sodium-140)/140] x TBW 📌p69
Calcium and albumin
Total serum calcium goes down 0.8mg/dL for every 1g/dL decrease in albumin
Albumin rv
3.5-5.5 g/dL
Calcium rv
Total calcium: 8.6-10.0 mg/dL (2.15-2.50 mmol/L) Ionized calcium 4.6-5.3 mg/dL (1.16-1.32 mmol/L)
Corrected AG
Actual AG + [2.5(4.5-albumin)]
Eponym for factor X`
Stuart factor
Other name for factor XI
Plasma thromboplastin antecedent (PTA)
Which congenital factor deficiency is assc’d with delayed bleeding after initial hemostasis
Factor XIII
In a previously unexposed patient, when does the platelet cout fall in HIT?
5-7 days
*if re-exposure: within 1-2 days
Describe HIT
A form of drug-induced immune thrombocytopenia (ITP)
Antibodies vs platelet factor 4 (PF4) are formed during exposure to heparin
Which of the following is the most common intrinsic platelet defect?
Storage pool disease
- dense granule deficiency is most prevalent
- storage site of ATP, ADP, Ca++, iphosphate
- may be an isolated defect or occur with partial albinism in the HERMANSKY-PUDLAK SYNDROME
- bleeding is primarily caused by the decreased release of ADP
An isolated defect of the alpha granules is known as
Gray platelet syndrome
Remarks on allergic blood transfusion reactions
Occurs in ~1% of all transufsions
May occur in any blood product, but are commonly assoc’d with FFP and platelets
What is the risk of HCV and HIV-1 transmissiosn with blood tranfusion?
1:1,000,000
What is the risk of HBV transmission with blood transfusion
1:300,000
Remarks on FFP
Required for the transfusion of facctor VIII or V (proaccelerin)
The most common clinical manifestation of a hemolytic transfusion reaction
Oliguria (58%)
Hemoglobinuria (56%)
Bank blood is appropriate for replacing each of the ff EXCEPT
Factor VIII
-labile, and 60-80% of activity is gone 1 week after collection
Remarks on volume receptors in the heart
Sensitive to changes in both chamber pressure and wall strtch, and are present within the atria of the heart.
They beome activated with LOW volume hemorrhage or mild reductions in RIGHT atrial pressure
Remarks on baroreceptors
Respond to LARGER reductions in intravascular volume
These receptors normally INHIBIT induction of ANS. When activated, these baroreceptors diminish their output, thus DISINHIBITING THE EFFECT OF THE ANS
Remarks on colloid solutions
Increase extracellular fluid deficit
Ionized fraction of serum calcium is decreased
Immunoglobulins drop
Reaction to tetanus toxoid given to the patient suffering form major trauma is decreased
Endogenous production of albumin also decreases
Remarks on tumor necrosis factor alpha (TNF-a)
Can be released as a response to bacteria or endotoxin
Peak within 90 mins of stimulation, and return to baseline within 4 hours
Leads to development of shock and hypopefusion
Contributes to muscle protein breakdown and cachexia
Levels in trauma are far less
Stab wound, hypotensive, markedly tachycardic, and appears confused. What percent of blood volume has he lost
> 40%
Most frequently encountered form of vasodilatory shock
SEPTIC SHOCK Other causes: -hypoxic lactic acidosis -carbon monoxide poisoning -decompensated and irreversible hemorrhagic shock -terminal cardiogenic shock -postcardiotomy shock
In septic shock, what is often given to patients with hypotension refractory to norepinephrine
Arginine vasopressin
Remarks on cardiogenic shock
Sustained hypotension (SBP<90) for at least 30 mins
Reduced cardia index (<2.2L/min per square meter)
Elevated pulmonary artery wedge pressure (>15mmHg)
Mortality rates are 50-80%
MCC: acute extensive MI
Cardigenic shock compolicates 5-10% of acute MI
Most common cause of death in patients hospitalized with acute MI
*typically not found on admission
*75% of patients who have cardiogenic shock complicating acute MIs develop signs of cardiogenic shock within 24 hours after onset of infarction (average 7 hours)
Corticosteroids in the treatment of septic shock
Improves mortality in patients with relative adrenal insufficiency
*no benefit in the intent of shock reversal
Remarks on serum lactate
Metabolized by the liver (50%) and kidneys (30%)
Indirect measure of magnitude and severity of shock
Prognostic factors:
1. Admission lactate level
2. highest lactate level
3. Time interval to normalize the serum lactate
100% survival if normalized withtin 24 hours
78% survival if normalized bet 24 and 48 horuos
14% survival if > 48 hours
