Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

APA > Intra-op Fluid Management > Flashcards

Intra-op Fluid Management Flashcards

1
Q

How do you replace fluid according to the historical school of thought?

A
  • insensible fluid loss—> from urine, feces, sweat, resp.
    • replace with 2mL/Kg/Hr
  • 3rd spacing: depends of size of fluid shift
    • minimal trauma: 3-4 ml/kg
    • moderate trauma: 5-6mL/kg
    • severe trauma 7-8mL/Kg
      (Huge incision)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is fluid loss replaced according to new thought/ periop goal directed fluid therapy (PGDT)?

A
  • use hemodynamic monitoring to guide fluid replacement
    • dilution: CO with PAC
    • pulse contour: vigileo/flow track
    • echo/es. Doppler
  • give 250mL bolus and monitor cardiac response to determine if pt needs fluids or meds (frank-starling curve)
  • ERAS—> build them up bore, then when we knock them down they don’t have as far to climb
    • minimizes fluids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is true regarding crystalloids?

A
  • cross plasma membrane- may dilute plasma proteins
    —> increased risk of pulmonary edema in large volumes
  • when replacing blood loss: crystalloid is 3 xs blood loss amount, in order to account for volume loss and 3rd spacing (historic)
    ** no glucose containing solutions—> BAD.
    Usually just use isotonic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is true regarding colloids?

A
  • use 1:1 to replace blood loss
  • colloids stay in plasma
  • hetastarch- not used much d/t coagulopathies (decreases factor VIII)
  • dextran- decreases platelet adhesiveness, potential for anaphylaxis, interferes with blood crossmatch—>not used much
  • 5% Albumin: used for rapid expansion of intravascular volume
    (25% causes higher pull, mostly used in ICU)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are s/s blood loss?

A
  • tachycardia, hypotension, decreased CVP, decreased mixed venous O2
    • give pain meds, if no ∆, give IVF
  • oliguria: <0.5ml/kg/hr
  • SBP/respiration variation >10mmHg (pulsus paradoxes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

A young healthy pt may lose 20% of circulating blood volume without clinical signs. Why is this?

A

Vessels can squeeze really tight, and heart can pump really hard to compensate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are indications for a blood transfusion?

A
  • primary indication is to increase O2 carrying capacity of blood
  • justified when Hg <6G/dL
  • CAD with acute anemia may transfuse <10g/dL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is acute hemorrhage managed?

A
  • when blood loss >1/3 entire blood volume —> give blood, not fluids
  • if blood loss causes hypovolemic shock , give blood
  • whole blood is preferred
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the major risk of a transfusion reaction?

A
  • incompatibilities to A, B antibodies, A, B, Rh antigen cause cause rapid hemolysis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is cross matching?

A

Incubating recipients plasma with donors RBCs

Takes about 45 min to complete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Emergency transfusions use O negative PRBCs. Why?

A
  • lacks a, b, Rh antigens

- will no be hemolysis by anti-a or anti-b antibodies that may be in the pts blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a risk of transfusing large amounts of O negative blood?

A

You have now changed their blood type.
—> now if you give their blood type it may react
* get type and crossed blood ASAP instead of running O -neg blood for a long time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is type specific blood?

A
  • 1st phase of crossmatch done- only tests for a,b, Rh antigens
  • chance of significant reaction is 1:1000
  • used only in emergency situations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a type and screen?

A
  • typed for a,b,Rh antigens, plus screened for most common antibodies
  • patients blood is NOT matched to donor unit-
  • allows for a unit of blood to be available for more than 1 pt
  • ordered for surgical procedures with remote risk of transfusion
    —> cross match is done after type and screen
  • chance of hemolytic reaction is 1:10,000
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What preservatives are in stored blood?

A
  • Phos.: buffer
  • dextrose: energy to RBCs
  • adenine—> to make ATP (adenine triphosphate) for metabolism-increases survival time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How long can blood be stored for and what is the reason for this?

A
  • 21-35 days

- it is required that 70% of RBCs be viable 24 hours after transfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the volume, Hct, and citrate level of whole blood?

A

Volume = 450mL
Citrate= 65mL
** Hct= 40% **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What components can be derived from whole blood?

A 
PRBCs
Platelets
FFP 
Cryoprecipitate
Albumin
Plasma proteins fraction
Factor VIII
Leukocyte poor blood
Antibody concentrates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the benefit of component therapy?

A

Allows for specific deficits to be corrected and longer storage time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some facts you should know when transfusing PRBCs?

A
  • one unit contains:
    Volume = 300mL
    Hct = 70%
  • Hgb should increase 1G/gL per unit PRBCs in 70 kg adult
  • when given with hypotonic solution, PRBC swelling and lysis
  • if calcium in solution—> clotting
  • only infuse with NS *
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some advantages of using PRBCs?

A
  • decreases potential for citrate toxicity compared to whole blood
  • decreases risk for allergic reaction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When is a platelet transfusion indicated?

A
  • platelets <50,000 cells/mm^3
  • with trauma or bleeding into brain, eye, airway a higher threshold may be used
  • platelet count should increase 5-10,000 cells/mm^3 in 70kg adult
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are risks of platelet transfusion?

A
  • viral disease transmission
  • human leukocyte antigens present on platelet cell membrane
  • bacterial infection in 1:12,000 transfusions
  • small risk of sepsis
24
Q

What is in FFP?

A
  • contains all plasma proteins
  • all coagulation factors except platelets
  • factor V and VIII
25
Q

When is FFP indicated?

A
  • Pt/Ptt > 1.5 xs normal and clinical indication of transfusion
  • reversal of warfarin
  • correction of known factor deficiency (von Wilderbrans)
26
Q

What is in cryoprecipitate?

A

High concentrations of:

  • factor VIII and XIII
  • von Wildebrans
  • fibrinogen and fibronectin
27
Q

Which component has the highest amount of von Wildebrand factor?

A

FFP has the highest total amount

While cryoprecipitate has the higher concentrated amount

28
Q

When is cryoprecipitate indicated?

A
  • factor VIII deficiency (hemophilia A)
  • von Willdebrands factor deficiency
  • fibrinogen deficiency
29
Q

During MTP what is the ratio of PRBC:FFP:Platelets?

A

4:1:1

30
Q

What are the 3 types of transfusion reactions?

A

Febrile
Allergic
Hemolytic-life threatening

31
Q

What happens during a febrile transfusion reaction?

A
  • antibodies react with antigens
    ** most frequently occurring reaction *
  • s/s:
    Fever
    Chills
    HA
    Myalgias
    Nausea
    Productive cough
    *typically not life threatening *
32
Q

What is the treatment for a febrile transfusion reaction?

A
  • check pt’s serum and urine for hemolysis (r/o hemolytic reaction)
  • slow down the rate and give anti-pyretics
33
Q

What is happening during an allergic transfusion reaction?

A
  • incompatible plasma proteins in donor blood
  • s/s:
    Urticaria (rash on chest, seen first)
    Pruritis
    Occasional facial swelling
34
Q

What is the treatment for an allergic transfusion reaction ?

A
  • Stop transfusion
  • Make sure its not a hemolytic reaction by checking urine and plasma for free Hgb
  • Administer IV antihistamine (Benadryl)
35
Q

What is a hemolytic transfusion reaction?

A

STOP TRANSFUSION IMMEDIATELY

  • from giving erroneous blood to pt
  • recipients antibodies attack donor blood
  • as little as 10mL blood can result in fatal hemolytic reaction
  • severity is proportional to volume transfused
    • may result in renal failure and DIC
36
Q

What are s/s hemolytic transfusion reaction?

A 
Fever
Chills
CP
Hypotension
Nausea
Flushing 
Dyspnea
Hemoglobinuria (red urine)
** anesthetics mask all s/s but hypotension and hemoblobinuria
37
Q

What labs results will be seen in a hemolytic transfusion reaction?

A
  • Dx made by direct antiglobulin test
  • draw: plasma and urine Hgb, billirubin
    • billirubin peaks 3-6 hrs after start of transfusion
38
Q

What is the treatment for hemolytic transfusion reaction?

A
    • stop transfusion **
  • Prevent renal failure by giving enough fluids to maintain UOP @ 100mL/hr by running LR and giving Mannitol or lasix
  • give bicarbonate to alkalize the urine and stop crystal ppt
  • labs: [Hgb], baseline coags, urine
  • return blood to lab with repeat crossmatch from pt
39
Q

What types of metabolic abnormalities can occur from blood therapy?

A
  • elevated H+ and K+—> body compensates—> become alkalotic
  • decreased 2.3 DPG
  • decreased Ca—> citrate binds free Ca
  • all of these potentially result in a left shift—> leads to tissue hypoxia
    (Typically not seen, but theoretical)
40
Q

The pH of stored blood is 7.1-6.9 d/t increased levels of CO2 in stored blood. Why does it not make your blood acidic?

A

Recipient eliminates CO2 via the lungs

Citrate metabolizes to bicarbonate upon transfusion

41
Q

How much K+ is in a unit fo blood?

A

20-30mEq/L

Usually insignificant until large volumes transfused and pt has underlying dz (renal)

42
Q

Why is hypocalcemia observed with blood therapy and how is it treated?

A
  • citrate binds to Ca in plasma
    • worse with hypothermia, liver disease and hyperventilation
  • rarely requires tx
    Give 1 G Ca Cl IV or 3 G calcium gluconate
43
Q

What are the viruses transmitted by blood therapy?

A
  • HIV—>1:1 million
  • hepatitis—> 1:60,000
  • cytomegalovirus
44
Q

What are microaggregates?

A

From stored whole blood —> platelets and leukocytes

  • concern they will accumulate in the lungs and obstruct vasculature causing ARDS
  • prevention:
    • transfuse whole blood through a fine filter (10-40 nm diameter) ( standard filters are 170nm diameter, much larger)
45
Q

What happens with hypothermia with blood therapy?

A
  • erratic EKG, cardiac irritability
  • post op shivering—> increases myocardial demand
    —> run blood through a warmer
46
Q

What are coagulation disorders with blood therapy?

A
  • dilutional thrombocytopenia
  • s/s:
    Frank bleeding without clotting at surgical site
    Hematuria
    Spontaneous oozing from puncture sites
47
Q

What do you need to know about DIC?

A
  • causes:
    • significant tissue damage with release of toxins
    • large amount of transfused blood
      LABS:
    • prolonged PT and PTT
    • decreased fibrinogen
    • increased fibrin split products
      TREATMENT:
    • treat underlying cause
    • give FFP and platelets
48
Q

What is TRALI?

A
  • occurs within 6 hours
  • acute non cardiac pulmonary edema
  • supportive treatment
  • most spontaneously recover
49
Q

What is immunosuppression with blood therapy related to?

A
  • r/t volume of plasma ( whole blood > immonusupression than PRBCs)
  • beneficial in transplant pts
  • bad with malignancy
50
Q

What happens with autologous blood transfusion?

A
  • pt donates own blood weeks prior to surgery
  • decreased risk of complications
  • consider when significant surgical blood loss anticipated
    (Still stored blood so have those risks)
51
Q

What is itraoperative salvage?

A

Considered when blood loss expected from a CLEAN WOUND

  • Contradinicated:
    • malignancy
    • blood borne diseases
    • bowel content contamination
52
Q

What is the make up of cell saver blood?

A

Hct= 50-60%
PH is alkaline—> CO2 hasn’t had a chance to build up yet
- only returning PRBCs

53
Q

What are complications of intra- op salvage?

A
  • dilutional coagulopathy
  • mixed with heparin so anticoagulation can occur
  • hemolysis
  • air/fat embolism
  • sepsis
  • DIC
54
Q

What is the hemodilution technique?

A

Removed pts blood the same day as surgery and store it
- transfuse after major blood loss over
- replace lost volume with IVFs
- dilutes blood loss during surgery
Contraindicated: anemia, severe cardiac or neuro. Disease

55
Q

How is EBL replaced?

A
  • crystalloids- 3:1

- colloids and blood- 1:1

APA (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions