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apa 1 /sim S. Horvath > intra-op fluid management > Flashcards

intra-op fluid management Flashcards

1
Q

three ways we lose fluids intraoperatively

A

insensible, third space, blood

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2
Q

what does insensible loss include

A

urine, feces, sweat, resp tract.

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3
Q

how do you correct insensible losses

A

2ml/kg/hr

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4
Q

third space loss - fluid moves from

A

intravascular space to interstitial space

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5
Q

minimal trauma third space loss

A

3-4ml/kg

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6
Q

moderate trauma third space loss

A

5-6 ml/kg

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7
Q

severe trauma

A

7-8 ml/kg

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8
Q

3rd space losses become mobilized on about the ___ day post op

A

third

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9
Q

goals of preoperative goal directed fluid therapy

A

minimize O2 demand and optimize CO and tissue oxygenation

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10
Q

PGDT implement…

A

baseline assessment of target hemodynamic measures, administer small fluid bolus (200-250ml) to assess FS curve, end points identified and fluid given to maintain.

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11
Q

the volume of cystalloid used to replace the intraoperateive blood loss should be ___ times the estimated blood loss

A
  1. why? because volume replacement must replenish both the volume lost from the intravasucalr space and the volume transferred from the extravascular space to the intravascular space to maintain the plasma volume during times of acute hemorrhage
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12
Q

surgical stress normally induces ____glycemia

A

hyper

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13
Q

examples of colloids

A

albumin, plasmanate, hetastarch, dextra

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14
Q

colloid replacement ratio

A

1:1

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15
Q

advantage of colloids

A

lack of risk of disease transmission. risk of transmitting hepatitis eliminated

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16
Q

disadvantages of colloids

A

lack of O2 carrying capacity. lack of coagulation factors , expensive

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17
Q

infusion of large volumes of hetastarch or dextran can cause ____

A

dilution coagulopathy . because of a decrease in factor VIII

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18
Q

dextran risk for

A

anaphylactic/ anaphylactoid reactions , decrease platelet adhesiveness. agglutination of RBC so intereferes with crossmatching.

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19
Q

what is used for rapid expansion of intravascular fluid volume

A

5% albumin

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20
Q

25% albumin is primarily indicated for

A

hypoalbuminemia

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21
Q

intraop blood loss is characterized by ___tension and ___cardia, ___ CVP, ___mixed venous O2

A

hypo, tachy, decreased, decreased

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22
Q

oliguria = ___ml/kg/hr

A

0.5-1

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23
Q

intraop blood loss will present how in terms of SBP?

A

variation of systolic BP with resp cycle in mechanically ventilated patients.

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24
Q

normally a ___mmHg variation d/t decreased venous return occurs with inspiration

A

8-10.

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25
Q

variations in SBP greater than __ my indicate hypovolemia

A

10

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26
Q

young healthy patients may lose __% of circulating blood volume without demonstrating clinical signs

A

20

27
Q

vasoconstriction of which vessels in response to blood loss? masks a blood loss of __%

A

splanchnic and venous capacitance. 10

28
Q

the primary indication for blood transfusion is

A

to increase the o2 carrying capacity of the blood

29
Q

transfusion is almost always justified when hgb is less than

A

6

30
Q

transfusion is rarely justified when Hgb is greater than

A

10

31
Q

should transfuse when blood loss is greater than ___ entire blood volume

A

1/3

32
Q

which is preferred to expand circulating blood volume and red cell volume… whole blood or PRBC’s?

A

whole blood

33
Q

crossmatching blood is done by

A

incubating the recipients plasma with the donor’s RBC’s

34
Q

how long does crossmatching take

A

3 step process, takes 45 min

35
Q

for emergency transfusion give

A

O neg (universal donor)

36
Q

whats the risk with infusing a lot of O neg blood

A

major intravascular hemolysis of O-neg by increasing titers of transfused anti-A and anti_B antibodies

37
Q

whats the risk if you keep on transfusing o-neg blood

A

minor hemolysis and hyperbilirubinemia

38
Q

typed specific blood

A

only typed for A, B, and rh anitigens

39
Q

typed specific blood risk of hemolytic transfusion reaction is

A

1 in 1000

40
Q

type and screened blood is screened for

A

the antigens as well as most common antibodies

41
Q

the chance of significant hemolytic reaction with typed and screen blood is

A

1 in 10,000

42
Q

3 preservatives in donated blood

A

phosphate, dextrose, adenine.

43
Q

phosphate acts as

A

buffer

44
Q

dextrose function

A

provides energy to RBC’s

45
Q

adenine function

A

allows RBC to resynthesize adenosine triphosphate to fuel their metabolic requirements and increase their survival time in storage.

46
Q

how long can you store blood for

A

21-35 days

47
Q

duration of blood storage is determined by the requirement that at least ___% of the RBC be viable for more than 24h after transfusion

A

70

48
Q

hematocrit of stored blood is

A

___%

49
Q

in a given unit of whole blood the volume of blood is ___ ml , the volume of citrate-containing preservative is ___

A

450, 65

50
Q

packed RBC has a volume of ___ and a hit of ___

A

300ml and 70% hct

51
Q

hemoglobin concentrations will increase by ___g/dl PRBC in a 70kg adult

A

1

52
Q

why shouldn’t you use hypotonic solutions to reconstitute PRBC’s

A

hypotonic solutions include glucose-containing solutions and plasmanate.. can result in RBC swelling and cell lysis

53
Q

reconstitution of PRBC’s in solutions containing calcium may result in

A

clotting

54
Q

PRBC’s have less potential for ___ toxicity with PRBC transfusion as compared to whole blood

A

citrate

55
Q

why do PRBC’s have a decreased risk of allergic reaction compared to whole blood

A

bc of decreased volume of plasma that is infused with PRBC’s

56
Q

platelets are indicated for counts less than ____ cells/mm3

A

50,000

57
Q

the platelet count will increase by ___ with each unit of platelets administered to the 70kg adult

A

5000 to 10000 cells/mm3

58
Q

risks of platelets

A

transmission of viral diseases, sensitization to human leukocyte antigens present on platelet cell membranes, bacterial infection in 1 of 12000 transfusions, small risk of platelet-related sepsis (fever after therapy)

59
Q

FFP =

A

the plasma portion of 1unit donated blood

60
Q

FFP contains all coag factors except

A

platelets. includes factor V and VII

61
Q

when is FFP indicated

A

reversal of warfarin therapy, when PT and/or PTT are >1-1.5x normal and there is a clinical indication of the need to transfuse

62
Q

what is cryoprecipitate

A

the plasma fraction that precipitates when FFP is thawed

63
Q

cryo contains high concentrations of

A

factor VII, von willebrand factor, factor XIII, fibrinogen, fibronectin

64
Q

indications for cryo

A

factor VII deficiency (hemophilia A), von willebrand factor deficincy

apa 1 /sim S. Horvath (17 decks)

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