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Cardiology > IV Fluids > Flashcards

IV Fluids Flashcards

1
Q

What is the distribution of total body water between different body compartments?

A

2/3= ICF (28L)

1/3= ECF (14L)

  • blood 5L= intravascular space (2L RBC + 3L plasma)
  • interstitial fluid 8L
  • trans cellular fluid
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2
Q

What is the normal body osmolality?

A

285 mosmol/kg H20

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3
Q

ICF and ECF have the same osmolality. How do they differ?

A 
Extra= Na+ dominant cation 
Intra= K+ dominant cation
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4
Q

What does it mean when a fluid is classified as physiological? Rank the different types of fluid from least to most physiological.

A

How similar the ion concentration of the fluid is to plasma

Dextrose
0.9% NaCl
Hartmann’s
Blood

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5
Q

What is the composition of dextrose solution? How does the solution act to increase circulating volume and when is it indicated?

A

Glucose dissolved in water

Glucose taken up by cells and water distributed in 2/3: 1/3 ration between ICF and ECF

Use:

  • insulin shock
  • hypoglycaemia
  • dehydration
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6
Q

What is the composition of saline? Where does it distribute to? How much would 1 litre of saline raise the plasma volume by?

A

NaCl in water

Has same Na+ content as ECF (145mmol/L) meaning it distributes into this compartment
-8:3 (3:1) ratio of interstitial fluid: plasma

250ml (3:1 )

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7
Q

What causes hyperchloraemic acidosis?

A

Excess saline results in plasma HCO3- being replaced with Cl- leading to METABOLIC ACIDOSIS

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8
Q

What is Hartmann’s solution composed of?

A 
Sodium 
Chloride 
Lactate 
Potassium 
Calcium
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9
Q

Where does Hartmann’s solution distribute to and by what ratio? What can this solution be used for?

A

3:1 ratio interstitial to plasma fluid

Use;
-resuscitation and maintenance fluids

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10
Q

What is the major differences between crystalloid and colloid? Give examples of the type of fluid for each.

A 
Crystalloid
-small molecules dissolved in water which quickly distributes throughout compartments 
Eg:
-dextrose 
-0.9% saline 
-Hartmann’s

Colloid
-large molecules in isotonic fluid= gelatine/carbohydrates/starch
I.e. MW >30000

Eg:

  • gelofusine
  • hydroxyethyl starch
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11
Q

How do colloid fluids utilise starling forces to increase intravascular volume?

A

They counteract capillary hydrostatic forces by exerting oncotic pressure in BV to ensure fluid stays in vessels to maximise the plasma volume

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12
Q

What are the mains uses of crystalloid fluids?

A

BASIC= increase intravascular volume to increase tissue perfusion

Replace:
-distributive shock

Maintain:
-perioperative patient who is NBM but otherwise ok

Traumatic brain injury= saline + mannitol

Metabolic acidosis secondary to renal failure= sodium bicarbonate

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13
Q

When is the use of colloid fluids indicated?

A

Massive haemorrhage i.e. when intravascular space needs filling quickly

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14
Q

When is hydroxyethyl starch (colloid) contraindicated? Why?

A

Critically ill/ sepsis/ burns

Patients have increased vascular permeability which can result in colloid leaking out into vasculature

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15
Q

What are the different components that blood can be given in? Which part of the blood is usually removed and why?

A 
Red cells 
Platelets 
Fresh frozen plasma 
Albumin 
Cryprecipitate

WCC
-decreases immunoreaction, febrile transfusion reactions and CMV

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16
Q

What are packed red cell solution formed from?

A

RBC suspended in iso-osmolality SAGM solution (saline/adenine/glucose/mannitol)

17
Q

What are the most important antigens to look for in blood before transfusion? How are they formed?

A

Rhesus D antibodies
I.e. IgG anti-D antibodies can lead to haemolytic transfusion reaction

Cause:
-RHD -ve receives RHD +ve blood or has RHD +ve baby

18
Q

What is 0 negative blood and when is it used?

A

No A or B antigens or RHD (no risk of incompatibility reactions)

Emergencies:
Deranged physiology
-class III/IV shock
-SBP <80
-HR >120
-INR> 1.5

Trauma

Obstetric emergency

19
Q

What is blood screened for in the UK?

A

Blood group

Rh type (+ve or -ve)

Syphilis

HBV

HIV

HCV

HEV

HTLV

20
Q

What checks need to be done pre, during and after transfusion?

A

Vital signs

  • temp
  • BP
  • HR
  • RR

Signs of reaction

  • rash
  • fever
  • headache
  • swelling
21
Q

What are the potential ABO incompatible transfusion reactions that can occur? What are the symptoms of this reaction?

A

Person with type A blood receiving type B or AB blood, they will create antibodies against the B antigens and lead to immune reaction to destroy the transfused RBC

Fevers + chills
Breathing difficulty 
Muscle aches 
Nausea 
Chest + abdo pain 
Blood in urine 
Jaundice
22
Q

How can you differentiate between the 4 classes of haemorrhagic shock?

A

Class 1
Blood loss= <750ml <15% BV
HR= same or slight +
BP= same

Class 2
Blood loss= 750-1000ml 15-30% BV
HR= +
BP= same

Class 3
Blood loss= 1500-2000ml 30-40% BV
HR= ++
BP= -

Class 4
Blood loss= >2000ml >40% BV
HR= ++
BP= - -

23
Q

Why is blood pressure able to be maintained in class 2 haemorrhagic shock but falls in class 3?

A

Class 2= vasoconstriction able to maintain MABP

Class 3= vasoconstriction no longer able to compensate for fall in BV which leads to fall in BP

24
Q

What needs to be assessed to determine a patients fluid status?

A

Clinical situation i.e. is patient suffering from sepsis or blood loss
Thirst i.e. indicator of dehydration
Vital signs
Urine output i.e. indicator of kidney perfusion
Skin turgor + capillary refill i.e. indicator of peripheral perfusion
Mucous membranes i.e. dry with dehydration
JVP
Lung fields for breathing sounds
Oedema
Daily weights

25
Q

What is the process of fluid resuscitation?

A

500ml bolus of crystalloids containing Na+ 130-154mmol/L over <15mins i.e. STAT!
NOTE: bolus can range from 250-1000ml depending on body habitus and dehydration situation

Patient needs to be reassessed to see if the patient has responded to the fluid challenge

Bolus can be given until 2000ml bolus given

26
Q

What action needs to be taken if patient not responding to >2000ml stat bolus?

A

Refer to ICU because it is possible that patient is fluid unresponsive

27
Q

How do we assess whether patient it respond to fluid resuscitation?

A

ABCDE

Reassess parameters:

  • pulse
  • blood pressure
  • conscious level (brain perfusion) i.e. GCS or AVPU
  • urine output (kidney perfusion)

Cardiology (15 decks)

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