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Emergency Medicine > IV Fluids > Flashcards

IV Fluids Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Is the majority of fluid in our body inside or outside of our cells?

A

intracellular fluid (ICF)

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2
Q

Is there more fluid in our interstitium or plasma?

A

Interstitial fluid

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3
Q

Do M or F have a higher fluid total body mass %

A

males

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4
Q

are these examples of intracellular or extraceullar fluid?

  • Cerebrospinal fluid
  • lymph
  • synovial fluid in joints
  • pleural fluid
  • pericardial fluid
  • peritoneal fluid
  • aqueous humor of the eye
A

Extracellular (ECF)

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5
Q

Osmotic vs Hydrostatic pressures

A
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6
Q

We get our majority of water via

A

Food - 800mL
Drink water - 500mL
Oxidation - 300mL

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7
Q

we lose the majority of our water via

A

Urine - 500mL
Skin - 500mL
Resp tract - 400mL
Stool - 200mL

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8
Q

Maintenance vs Replacement fluids

A
  • Maintenance -> Replaces ongoing losses of water and electrolytes under normal physiologic conditions
  • Replacement -> Corrects existing water and electrolyte losses. (i.e. gastrointestinal, urinary, skin, bleeding, 3rd space sequestration)
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9
Q

pt is eating/drinking normally. Do they need maintenance IV fluids?

A

No

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10
Q

standard IV fluids order

A

Reasonable approach is to begin with 2 L per day of half normal saline in dextrose with 20mEq KCl per liter

Monitor Na+ and change as necessary

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11
Q

Do these ppl need A LOT or LITTLE water?

  • afebrile
  • not eating
  • physically inactive
  • oliguric kideny injury
  • use of humidified air
  • edematous states
  • hypothyroidism
A

a little (these ppl dont have high water demand or are already overfluided)

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12
Q

Do these ppl need A LOT or a LITTLE water

  • febrile
  • sweating
  • tachypnic
  • burned
  • polyric
  • ongoing GI losses
A

A LOT

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13
Q

What can you refer to to determine how much fluid is required for fluid replacement?

A

Use known wt loss, blood pressure, jugular venous pressure, urine sodium concentration/output, and hematocrit

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14
Q

Replacement fluids

In severe volume depletion or hypovolemic shock, at least ___L of isotonic fluids are given a rapidly as possible.

A

1-2L

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15
Q

Crystalloids

A
  • Contain organic and inorganic salts (e.g., glucose and sodium chloride) dissolved in sterile water
  • Ex. Normal saline, Lactated ringers, dextrose sol, bicarb sol
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16
Q

what makes lactated ringers special?

A

Contain sodium lactate in addition to NaCl

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17
Q

pt has metabolic acidosis, can you still give lactated ringers?

A

yes, sodium lactate is NOT an acid. it metab into bicarb

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18
Q

Normal saline (____%) is isotonic and used for resuscitation

A

0.9

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19
Q

___% saline is hypotonic and used for maintenance

A

0.45%

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20
Q

____% saline is hypertonic and given for severe hyponatremia to prevent cerebral edema

A

3%

21
Q

D5W

A

Dextrose sugar water
starts off isotonic and then has hypotonic final effect
used for hypernatremia and hypoglycemia

22
Q

What tonicity are lactated ringers and are they used for Resuscitation or maintenance?

A

Isotonic
Resuscitation

23
Q

do isotonic fluids enter the intracellular fluid?

A

no, but hypotonic fluids do

24
Q

What tonicity are Resuscitation fluids?

A

Isotonic

25
Q

What tonicity are Maintenance fluids?

A

Hypotonic

shove the fluid into the cells

26
Q

most crystalloids start to leave the venous system within ___ hrs, sometimes up to ___hrs if critically ill

A

2 hrs
up to 8 hrs if critically ill

27
Q

Caution: in some cases too much NS can cause a ________ ________(non-anion gap acidosis)
Be wary of fluid overloading your patients

A

hyperchloremic acidosis

28
Q

should you use lactated ringers for true end-stage liver disease?

A

No

29
Q

can lactated ringers be given to a patient with hyperkalemia?

A

yes, the 4mL equivalents of K in the lactated ringers will not drastically incr K+ levels (10mL for every 1K?)

30
Q

what is the preferred maintenance fluid?

A

D5-0.45%NS + 20mEq K+

Tonicity goes from Hypertonic -> Hypotonic

31
Q

Normal plasma Osmolarity is ~ ______mOsm/L

A

290

32
Q

What IV fluid do you use for symp hyponatremia and to reduce cerebral edema?

A

3% Saline (Hypertonic)

Given as a bolus of 50 or 100mL initially or run at low rate for short periods

33
Q

What IV fluid is given to correct kidney failure or refractory metabolic acidosis

A

Sodium Bicarbonate Sol

Usually made in a medium of D5W, 1/2NS, D5W1/2NS, Sterile water Select 50, 100, or 150mEq sodium bicarbonate to 1L of fluid

34
Q

Colloid solutions

A
  • Contain large proteins that cannot cross capillary walls (proteins stay in vasculature)
  • Hypertonic solution pulls fluid from interstitial & extracellular spaces AND INTO THE VASCULATURE
  • Increases Intravascular vol & BP

Note: Equal survival rate among patients treated with colloids or crystalloids when given for hypotensive issues

35
Q

What is the MC used colloid solution

A

Human Albumin (5% or 25%)

36
Q

Human Albumin comes in ___% or _____%

A

5% or 25%

37
Q

Signs of Dehyrdations:
* No wet diapers for ____hrs
* BUN/Creatinine Ratio >____
* Urine Specific Gravity > ______

A
  • No wet diapers for 3 hrs
  • BUN/Creatinine Ration > 20
  • Urine Specific Gravity > 1.030
38
Q

Max daily fluid vol for Adults and Children

A

Adults: 2L
Children: 2400mL

39
Q

1kg = ____lbs

A

2.2

40
Q

Use the 4:2:1 rule to determine ____

A

How much fluids to give a child per hour

41
Q

The hourly infusion rate for a 60kg Child is _____mL/hr

use the 4:2:1 rule

A

100mL/Hr

42
Q

Consider Intraosseous Infusions (IO) if vascular access can not be obtained within ___ attempts or for >_____sec (collapses in on itself)

A

2 attempts
>90 seconds

43
Q

Absolute Contraindications for IO

A
  • Fractures or prev penetrated bone (fluids will leak out)
  • Extremity with vascular interruption
  • Cellulitis, burns, osteomyelitis -> SEPSIS
  • Caution in Osteoporosis/Osteogenesis imperfecta
44
Q

The EZ-IO drill needle length is based on _____

A

body weight

45
Q

Drill into the _____ or _____ for IO

A

Humerus or Tibia

46
Q

Drill into the _____ or _____ for IO

A

Humerus or Tibia

47
Q

Intraosseous (IO) devices

Impact-driven devices are inserted into the ______

A

sternum

Pts must be 12yo+Sternal EZ-IO PPT

48
Q

IO Complications

A
  • Infusion pain -> Lidocaine 2% slow push
  • Tibial frx
  • Extraversion of fluid or meds into surrounding tissues (Compartment syndrome)
  • Infx -> Osteomyelitis -> sepsis
49
Q

Which is more painful: inserting the IO device or infusing through the device?

A

Infusing can be so painful that it makes ppl nauseous. Slowly push 2% lidocaine thru the IO device

Emergency Medicine (11 decks)

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