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