L10 Fluids & transfusion in hypovolaemia

Question 1

osmolarity

Answer 1

Osmolarity is the measure of a solute concentration per unit volume of solvent

The solute is what is dissolved
Solvent what it is dissolved in

Question 2

solute

Answer 2

is what is dissolved

Question 3

solvent

Answer 3

what it is dissolved in

Question 4

osmolality

Answer 4

osmolality is the measure of solute concentration per unit mass of solvent

Question 5

osmolality is the same in the ICF and in the

Answer 5

ECF

Question 6

tonicity

Answer 6

tonicity is the measure of osmotic pressure gradient between two solutions

tonicity is only influenced by solutes that cannot cross the semipermeable membranes

Question 7

normal fluid percentage in body

Answer 7

2/3
ICF - 2/3 of above ECF is 1/3
intravacualr to instal is 3/4 to 1/4 of ICF
using ECF - plasma is 3 litres ( intervascualr ) and 10.5 l is interstitial

Question 8

hypovolaemia

Answer 8

• A decreased volume of circulating blood in the body- docent suddenly happen

Question 9

what detects a hypovolaemic state

Answer 9

hypothalamus

and cuase pp to release vasopressin ( vasoconstrictor and retian fluids via aquaproisn)
Symapthic – adrenal medulla adrenalien – vasoconstrictor
Also causes reduction in renal blood flow due to vasoc icnreasng renin. ,angiotension anad aldosterone- fluid retneiona and sodium retention

Antiero pituaitry increase in growth hromoen and ACTH increasing cortisol levels

Question 10

what controls the endothelial entry of fluids into the interstitial space

Answer 10

glycocalyx

Question 11

main drug causes of hypovolamia

Answer 11

Loop diuretics – offload to much fluid

Corticosteroids – fluid retention

Question 12

examples of maintainanc fluid

Answer 12

normal plasma
o.9 NaCl ( saline)
5% dextrose
hartmanns solution

Question 13

how many stages of hypovolaemic shock

Answer 13

4 - more fluid loss , increased RR and tachycardia, decreased systolic

Question 14

what is the first sign to change in a deteriorating or shocked patient

Answer 14

RR - increases to compensate for an underlying metabolic acidosis

Question 15

Crystalloids are what

Answer 15

aqueous solution of electrolytes with no large molecules therefore there will be no oncotic pressure

Question 16

crystalloids include what

Answer 16

0.9% saline
5% dextrose
hartmanns

Question 17

benefits of crystalloids

Answer 17

easy to store, not expensive, long shel f life, readily available , low incidence of adverse reactions , variety of formulas and used for maintenance and replacement and there is no religious objection to this

Question 18

isotonic salien 0.9% NaCl is given into what space

Answer 18

intravascular and then into the interstitial space and the distribution is due to increase hydrostatic pressure between the intravascular compartment and the interstitial compartment

Question 19

dextrose fluid which is hypotonic will go from intravacualr to interstitial to intracellular and the glucose is rapidly taken up by cells leaving pure water
would you use it in resuscitation

Answer 19

no you wouldn’t use it in resus you would use the isotonic saline ( 0.9 NaCl)

Question 20

colloids are human albumin solution of 5-20% containing starch , dextran and gelofusin do they just remain int eh intravascular space

Answer 20

yes as the oncotic pressure draws fluid into the intravascular space

Question 21

colloids have no oxygen carrying capacity as the oncotic effect is weakened. what are the adverse reactions associated with use of these

Answer 21

renal failure , anaphylaxis and coagulopathy

Question 22

74 year old lady is admitted with a fractured neck of femur awaiting surgical fixation. She is unwell and confused. On examination she has cold peripheries. Her observations are: Pulse 115 bpm Blood pressure is 92/ 55 mmHg RR 22 Temperature 35 degrees A diagnosis of hypovolaemic shock is made. What is your initial resuscitation fluid of choice?

Answer 22

0.9% saline

Question 23

A 30 year old man presents to the Emergency Department after a traumatic amputation below his right knee. Whilst awaiting intravenous cannulation for resuscitation with fluids, a tourniquet is applied to the right thigh. Unfortunately, there is on-going blood loss which is estimated to be 1.5 litres. This patient is likely to:

Answer 23

Be hypotensive, tachycardia and tachypnoeic grade 3 shock

Question 24

Unlike crystalloids , red cell transfusion increase oxygen carrying capacity a well as volume
Single unit contains 250-300 ml of conc bloo d
Haematocrit is 0.6 in normal blood this is 0.35
1x packed RBC would expect to increase Hb by 10g/L

at what temp should you store blood

Answer 24

4 degrees

Question 25

what is a major haemorrhage

Answer 25

loss of more than one blood volume within 24 hours - or 50% of total blood lost in 3 Hours

Question 26

major haemorrhage protocol

Answer 26

stop the bleeding and ABC 
activate protocol 
blood pack - 4 blood, x2 FPP ( 20 mins to defrost) 
then 2:1 blood to FFP 
reassess after 4 units