IVF- maintenance and resuscitation Flashcards
What are the common electrolytes in NS and its osms?
-Na 154
-Cl 154
-mOsm 308
What are the common electrolytes in LR and its osms?
-Na 130
-Cl 109
-K 4
-Ca 3
-HCO3 source = 28 lactate
-mOsm 273
What are the common electrolytes in plasmalyte and its osms?
-Na 140
-Cl 98
-K 5
-Mg 3
-HCO3 source = 27 acetate 23 gluconate
-mOsm 296
What are the common electrolytes in 5% albumin and its osms?
-Na 145
-Cl 145
-mOsm 290
-other = 50g/L albumin
What are the common electrolytes in hespan and its osms?
-Na 154
-Cl 154
-mOsm 308
-60g/L hetastarch
What are the common electrolytes in hextend and its osms?
-Na 130
-Cl 109
-K 4
-Ca 3
-HCO3 source = 28 lactate
-mOsm 273
-60g/L hetastarch
What are the common electrolytes in D5 1/2NS + 20KCl and its osms?
-Na 77
-Cl 97
-K 20
-mOsm 444
-50g/L dextrose
What are the predominant cations in ICF?
-K
-Mg
What are the predominant anions in ICF?
-proteins
-phosphate
-bicarbonate
-sulfate
What is the predominant cations in ECF?
Na
What are the predominant anions in ECF?
-Cl
-bicarbonate
What are the 3 varieties of synthetic colloids?
-hydroxyethyl starch (HES)
-gelatin
-dextran
What can happen with excessive NS use?
-nongap acidosis
-renal arteriolar vasoconstriction
-renal inability to excrete salt loads
-reduced gastric blood flow
-impaired cardiac contractility
-pulm inflammation
-neutrophil activation
Which type of lactate enantiomer is more pro-inflammatory?
D-lactate
Which type of lactate enantiomer is in LR?
most formulations are racemic mixtures (this is not physiologic) but Baxter manufactures LR with only L-lactate
How much of a crystalloid bolus remains intravascular after a few hours?
~20%
Physical exam signs of hypervolemia?
-pitting or sacral edema
-anasarca
-distended neck veins
Physical exam signs of hypovolemia?
-poor skin turgor
-sunken eyes
-dry mucus membranes
-flat neck veins
-weak peripheral pulses
When is the FENa the most accurate?
without an acute kidney injury and if patient is not given diuretics
In hypervolemia without an acute pulmonary abnormality what can be helpful in determining the interstitial lung water?
P/F ratio
-if high = low interstitial volume which could = low intravascular volume
What pulse pressure variation is predictive of fluid responsiveness?
> 12%
-note: doesn’t mean pt needs fluids just that pt’s cardiac failure is still in up-sloping part of Frank-Sterling curve
The assumption of the vigileo is that pulse pressure correlates with what?
stroke volume
- it uses this to predict stroke volume variation and cardiac output
What restrictions are there on the accuracy of the SVV on the vigileo?
-pt must be ventilated w/ complete respiratory support
-can’t have any significant arrhythmias (including Afib)
-no RV failure
In a damage control resuscitation situation how does hypothermia lead to increased mortality?
-reduces platelet function
-decreases the reactions of coagulation enzymes and fibrinogen synthesis
In a damage control resuscitation situation how does large-volume crystalloid infusion lead to increased mortality?
-dilution of clotting factors leads to/worsens coagulopathy
-unwarmed fluids worsens hypothermia
-hyperchloremia worsens metabolic acidosis
What is the hemotocrit, platelet count, and clotting factor activity of 1u of whole blood?
-this is 500mL of whole blood
-hematocrit 38-50%
-platelets 150k - 400k
-100% activity of clotting factors
What is the hemotocrit, platelet count, and clotting factor activity of 1u of packed red blood cells?
-this is 660mL of blood
-hematocrit 29%
-platelets 88k
-65% activity of clotting factors
Theoretically what does CVP reflect when using it to guide resuscitation?
cardiac preload and overall volume status
What is the goal CVP for resuscitation in the surviving sepsis campaign?
8-12mmHg
Where is a true mixed venous oxygen saturation obtained from?
pulmonary artery
-therefore requires pulmonary artery catheter
What is the SvO2 and ScvO2 goal for resuscitation in the surviving sepsis campaign?
-SvO2 65mmHg
-ScvO2 70mmHg
What diameter of the IVC correlates with worse outcomes in trauma?
< 2cm
What initial lactate level was shown to be a predictor of in hospital mortality?
3.4mmol/L or above
During what time frame should lactate clear?
within 48h, after this is an increase in mortality
What type of resuscitation fluids can falsely elevate the base deficit?
high chloride containing fluids
Why are TEGs better than coag studies in trauma patients?
-INR tends to overestimate coagulopathy
-data shows that hyperfibrinolysis is often the cause of coagulopathy in trauma pts
What percentage of total weight is the approximate total body water of a patient?
60%
What percentage of total weight is the approximate total body water of a patient > 80yo?
50%
What percentage of total body weight is the intracellular weight?
40%
What percentage of total body weight is the extracellular weight?
20%
What is the extracellular volume made up of?
-interstitial fluid
-plasma volume
What percentage of the extracellular volume is the plasma volume? The total body weight?
-25%
-5%
What percentage of the extracellular volume is the interstitial fluid?
75%
What is the approximate daily insensible loss?
8-12mL/kg/day
What is the approximate daily loss from the GI tract?
100 - 200mL/day
How does hyperthermia affect insensible losses?
For every degree above 37C loses increases by 10%
What is the ratio that crystalloids should replace blood loss?
3-4:1
d/t shift of crystalloid from the intravascular space to the interstitium
How long postop can the capillary leak that occurs w/ soft tissue dissection persist?
24hrs
