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Acid/base/electrolytes/fluids > IVF- maintenance and resuscitation > Flashcards

IVF- maintenance and resuscitation Flashcards

1
Q

What are the common electrolytes in NS and its osms?

A

-Na 154
-Cl 154
-mOsm 308

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2
Q

What are the common electrolytes in LR and its osms?

A

-Na 130
-Cl 109
-K 4
-Ca 3
-HCO3 source = 28 lactate
-mOsm 273

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3
Q

What are the common electrolytes in plasmalyte and its osms?

A

-Na 140
-Cl 98
-K 5
-Mg 3
-HCO3 source = 27 acetate 23 gluconate
-mOsm 296

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4
Q

What are the common electrolytes in 5% albumin and its osms?

A

-Na 145
-Cl 145
-mOsm 290
-other = 50g/L albumin

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5
Q

What are the common electrolytes in hespan and its osms?

A

-Na 154
-Cl 154
-mOsm 308
-60g/L hetastarch

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6
Q

What are the common electrolytes in hextend and its osms?

A

-Na 130
-Cl 109
-K 4
-Ca 3
-HCO3 source = 28 lactate
-mOsm 273
-60g/L hetastarch

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7
Q

What are the common electrolytes in D5 1/2NS + 20KCl and its osms?

A

-Na 77
-Cl 97
-K 20
-mOsm 444
-50g/L dextrose

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8
Q

What are the predominant cations in ICF?

A

-K
-Mg

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9
Q

What are the predominant anions in ICF?

A

-proteins
-phosphate
-bicarbonate
-sulfate

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10
Q

What is the predominant cations in ECF?

A

Na

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11
Q

What are the predominant anions in ECF?

A

-Cl
-bicarbonate

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12
Q

What are the 3 varieties of synthetic colloids?

A

-hydroxyethyl starch (HES)
-gelatin
-dextran

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13
Q

What can happen with excessive NS use?

A

-nongap acidosis
-renal arteriolar vasoconstriction
-renal inability to excrete salt loads
-reduced gastric blood flow
-impaired cardiac contractility
-pulm inflammation
-neutrophil activation

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14
Q

Which type of lactate enantiomer is more pro-inflammatory?

A

D-lactate

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15
Q

Which type of lactate enantiomer is in LR?

A

most formulations are racemic mixtures (this is not physiologic) but Baxter manufactures LR with only L-lactate

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16
Q

How much of a crystalloid bolus remains intravascular after a few hours?

A

~20%

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17
Q

Physical exam signs of hypervolemia?

A

-pitting or sacral edema
-anasarca
-distended neck veins

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18
Q

Physical exam signs of hypovolemia?

A

-poor skin turgor
-sunken eyes
-dry mucus membranes
-flat neck veins
-weak peripheral pulses

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19
Q

When is the FENa the most accurate?

A

without an acute kidney injury and if patient is not given diuretics

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20
Q

In hypervolemia without an acute pulmonary abnormality what can be helpful in determining the interstitial lung water?

A

P/F ratio
-if high = low interstitial volume which could = low intravascular volume

21
Q

What pulse pressure variation is predictive of fluid responsiveness?

A

> 12%
-note: doesn’t mean pt needs fluids just that pt’s cardiac failure is still in up-sloping part of Frank-Sterling curve

22
Q

The assumption of the vigileo is that pulse pressure correlates with what?

A

stroke volume
- it uses this to predict stroke volume variation and cardiac output

23
Q

What restrictions are there on the accuracy of the SVV on the vigileo?

A

-pt must be ventilated w/ complete respiratory support
-can’t have any significant arrhythmias (including Afib)
-no RV failure

24
Q

In a damage control resuscitation situation how does hypothermia lead to increased mortality?

A

-reduces platelet function
-decreases the reactions of coagulation enzymes and fibrinogen synthesis

25
Q

In a damage control resuscitation situation how does large-volume crystalloid infusion lead to increased mortality?

A

-dilution of clotting factors leads to/worsens coagulopathy
-unwarmed fluids worsens hypothermia
-hyperchloremia worsens metabolic acidosis

26
Q

What is the hemotocrit, platelet count, and clotting factor activity of 1u of whole blood?

A

-this is 500mL of whole blood
-hematocrit 38-50%
-platelets 150k - 400k
-100% activity of clotting factors

27
Q

What is the hemotocrit, platelet count, and clotting factor activity of 1u of packed red blood cells?

A

-this is 660mL of blood
-hematocrit 29%
-platelets 88k
-65% activity of clotting factors

28
Q

Theoretically what does CVP reflect when using it to guide resuscitation?

A

cardiac preload and overall volume status

29
Q

What is the goal CVP for resuscitation in the surviving sepsis campaign?

A

8-12mmHg

30
Q

Where is a true mixed venous oxygen saturation obtained from?

A

pulmonary artery
-therefore requires pulmonary artery catheter

31
Q

What is the SvO2 and ScvO2 goal for resuscitation in the surviving sepsis campaign?

A

-SvO2 65mmHg
-ScvO2 70mmHg

32
Q

What diameter of the IVC correlates with worse outcomes in trauma?

A

< 2cm

33
Q

What initial lactate level was shown to be a predictor of in hospital mortality?

A

3.4mmol/L or above

34
Q

During what time frame should lactate clear?

A

within 48h, after this is an increase in mortality

35
Q

What type of resuscitation fluids can falsely elevate the base deficit?

A

high chloride containing fluids

36
Q

Why are TEGs better than coag studies in trauma patients?

A

-INR tends to overestimate coagulopathy
-data shows that hyperfibrinolysis is often the cause of coagulopathy in trauma pts

37
Q

What percentage of total weight is the approximate total body water of a patient?

A

60%

38
Q

What percentage of total weight is the approximate total body water of a patient > 80yo?

A

50%

39
Q

What percentage of total body weight is the intracellular weight?

A

40%

40
Q

What percentage of total body weight is the extracellular weight?

A

20%

41
Q

What is the extracellular volume made up of?

A

-interstitial fluid
-plasma volume

42
Q

What percentage of the extracellular volume is the plasma volume? The total body weight?

A

-25%
-5%

43
Q

What percentage of the extracellular volume is the interstitial fluid?

A

75%

44
Q

What is the approximate daily insensible loss?

A

8-12mL/kg/day

45
Q

What is the approximate daily loss from the GI tract?

A

100 - 200mL/day

46
Q

How does hyperthermia affect insensible losses?

A

For every degree above 37C loses increases by 10%

47
Q

What is the ratio that crystalloids should replace blood loss?

A

3-4:1
d/t shift of crystalloid from the intravascular space to the interstitium

48
Q

How long postop can the capillary leak that occurs w/ soft tissue dissection persist?

A

24hrs

Acid/base/electrolytes/fluids (3 decks)

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