intra-op fluid management

Question 1

three ways we lose fluids intraoperatively

Answer 1

insensible, third space, blood

Question 2

what does insensible loss include

Answer 2

urine, feces, sweat, resp tract.

Question 3

how do you correct insensible losses

Answer 3

2ml/kg/hr crystalloid

Question 4

third space loss - fluid moves from

Answer 4

intravascular space to interstitial space

Question 5

minimal trauma third space loss

Answer 5

3-4ml/kg

Question 6

moderate trauma third space loss

Answer 6

5-6 ml/kg

Question 7

severe trauma

Answer 7

7-8 ml/kg

Question 8

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

Answer 8

third

Question 9

goals of preoperative goal directed fluid therapy

Answer 9

minimize O2 demand and optimize CO and tissue oxygenation

Question 10

PGDT implement…

Answer 10

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

Question 11

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

Answer 11

3. 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

Question 12

surgical stress normally induces ____glycemia

Answer 12

hyper

Question 13

examples of colloids

Answer 13

albumin, plasmanate, hetastarch, dextra

Question 14

colloid replacement ratio

Answer 14

1:1

Question 15

advantage of colloids

Answer 15

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

Question 16

disadvantages of colloids

Answer 16

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

Question 17

infusion of large volumes of hetastarch or dextran can cause ____

Answer 17

dilution coagulopathy . because of a decrease in factor VIII

Question 18

dextran risk for

Answer 18

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

Question 19

what is used for rapid expansion of intravascular fluid volume

Answer 19

5% albumin

Question 20

25% albumin is primarily indicated for

Answer 20

hypoalbuminemia

Question 21

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

Answer 21

hypo, tachy, decreased, decreased

Question 22

oliguria = ___ml/kg/hr

Answer 22

< 0.5-1

Question 23

intraop blood loss will present how in terms of SBP?

Answer 23

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

Question 24

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

Answer 24

8-10.

Question 25

variations in SBP greater than __ my indicate hypovolemia

Answer 25

10

Question 26

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

Answer 26

20

Question 27

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

Answer 27

splanchnic and venous capacitance. 10

Question 28

the primary indication for blood transfusion is

Answer 28

to increase the o2 carrying capacity of the blood

Question 29

transfusion is almost always justified when hgb is less than

Answer 29

6

Question 30

transfusion is rarely justified when Hgb is greater than

Answer 30

10

Question 31

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

Answer 31

1/3

Question 32

For acute hemorrhage, which is preferred.. whole blood or PRBC's? and why?

Answer 32

whole blood bc it expands circulating blood volume and red cell volume

Question 33

crossmatching blood is done by

Answer 33

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

Question 34

how long does crossmatching take

Answer 34

3 step process, takes 45 min

Question 35

for emergency transfusion give

Answer 35

O neg (universal donor)

Question 36

whats the risk of transfusing patient specific typed blood after infusing O-neg blood?

Answer 36

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

Question 37

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

Answer 37

minor hemolysis and hyperbilirubinemia

Question 38

typed specific blood

Answer 38

only typed for A, B, and rh anitigens

Question 39

typed specific blood risk of hemolytic transfusion reaction is

Answer 39

1 in 1000

Question 40

type and screened blood is screened for

Answer 40

the antigens as well as most common antibodies

Question 41

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

Answer 41

1 in 10,000

Question 42

3 preservatives in donated blood

Answer 42

phosphate, dextrose, adenine.

Question 43

phosphate acts as

Answer 43

buffer

Question 44

dextrose function

Answer 44

provides energy to RBC's

Question 45

adenine function

Answer 45

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

Question 46

how long can you store blood for

Answer 46

21-35 days

Question 47

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

Answer 47

70

Question 48

hematocrit of stored blood is

Answer 48

___%

Question 49

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

Answer 49

450, 65

Question 50

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

Answer 50

300ml and 70% hct

Question 51

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

Answer 51

1

Question 52

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

Answer 52

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

Question 53

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

Answer 53

clotting

Question 54

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

Answer 54

citrate

Question 55

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

Answer 55

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

Question 56

platelets are indicated for counts less than ____ cells/mm3

Answer 56

50,000

Question 57

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

Answer 57

5,000 to 10,000 cells/mm3

Question 58

risks of platelets

Answer 58

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)

Question 59

FFP =

Answer 59

the plasma portion of 1unit donated blood

Question 60

FFP contains all coag factors except

Answer 60

platelets. includes factor V and VII

Question 61

when is FFP indicated

Answer 61

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

Question 62

what is cryoprecipitate

Answer 62

the plasma fraction that precipitates when FFP is thawed

Question 63

cryo contains high concentrations of

Answer 63

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

Question 64

indications for cryo

Answer 64

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