Lecture 3: Fluid Management Flashcards

1
Q

Steps in Acid Base interpretation

A
is it life threatening?
acidemic or alkalemic?
acute respiratory?
chronic respiratory vs acute metabolic?
if acute metabolic, resp compensation?
anion gap present?
is clinical presentation consistent with interpretation?
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2
Q

Anion gap equation

A

Na - (Cl + HCO3)
3-11 normal
>12 resp acidosis

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3
Q

Respiratory acidosis

A
PaCO2 > 45 pH < 7.35
compensated with renal retention of HCO3
decreased contractility, SVR
increased PVR
treatment: mech vent, HCO3, improve pulm function
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4
Q

Respiratory alkalosis

A

PaCO2 < 35 pH > 7.45

results in hypokalemia, hypocalcemia, dysrhythmias, bronchoconstriction, cerebrovascular constriction, hypotension

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5
Q

Metabolic acidosis

A

HCO3 < 21 pH < 7.35
decreased contractility, SVR
increased PVR
treatment: IV fluid, HCO3

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6
Q

Metabolic alkalosis

A

HCO3 > 27 pH > 7.45

treatment IV fluid, KCl

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7
Q

Base Excess

A

deviation of HCO3
0 normal
-2 - < 0 metabolic acidosis (base deficit)
> 0 - +2 metabolic alkalosis (base excess)

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8
Q

Who has more water weight?

A

Infants, men

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9
Q

Body fluid distribution

A

Of weight
60% TBW
40% intracellular
20% extracellular - 4% plasma, 16% interstitial

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10
Q

Most oncotically active part of ECV?

A

Albumin

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11
Q

healthy adult fluid requirements

A

2500ml/day

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12
Q

Maintenance fluid calculations

A

4 ml/kg/hr for 1st 10kg
2 ml/kg/hr for 2nd 10kg
1 ml/kg/hr for each additional kg

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13
Q

NPO fluid deficit calculation

A

maintenance fluid rate x hours NPO

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14
Q

Fluid deficit replacement strategy

A

1/2 in 1st hr
1/4 in 2nd hr
1/4 in 3rd hr

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15
Q

Blood soaked 4x4 volume

A

~10 ml

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16
Q

Blood soaked laparotomy pad

A

100-150 ml

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17
Q

Blood spill amounts

A

1 in = 5 ml
2 in = 20 ml
3 in = 45 ml
4 in = 80 ml

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18
Q

EBV for premature, term

A

95 ml/kg

85 ml/kg

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19
Q

EBV for infant, child

A

80 ml/kg

70 ml/kg

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20
Q

EBV for adult male, female

A

75 ml/kg

65 ml/kg

21
Q

Allowable blood loss equation

A

ABL = EBV x (starting Hct - allowable Hct) / starting Hct

22
Q

Evaporation loss estimations

A

Short case: 0-2 ml/kg/hr
moderate uncomplicated: 3-5 ml/kg
severe: 6-9 ml/kg
emergency 10-15 ml/kg

23
Q

Blood loss replacement ratios

A

crystalloid 3: 1

colloid 1:1

24
Q

Fluid therapy philosophy

A

avoidance of sodium and water overload

25
Goal directed fluid therapy
estimating based on changes to: Stroke volume variation pulse pressure variation systolic pressure variation
26
Lactated Ringers components
closely resembles plasma has lactate that converts to HCO3 to buffer has Ca
27
Normal Saline large dose
should switch to something else due to chloride content = acidosis
28
Normosol-R
has Mg, acetate | no Ca
29
D5W calories
170-200/L
30
Hypertonic solution uses
used for slow resuscitation
31
Colloid half life
16 hrs, as short as 2-3 hrs
32
Albumin risks, sizes, oncotic pressure
allergic reaction, 5%/25% molecular size, 20 pressure
33
Dextran components
water soluble glucose polymers
34
Dextran 70 use
volume expansion
35
Dextran 40 use
prevents thrombosis | less viscosity, good for microvascular cases
36
Dextran side effects
anaphylactic reaction, platelet inhibition, pulm edema, crossmatching problems
37
Hetastarch components, problems, max dose, oncotic pressure
``` plant starch as effective as albumin, less expensive issues with coagulopathy w/ dilutional thrombocytopenia max dose < 20 mg/kg/day 30 oncotic pressure ```
38
Benefits of crystalloids
equally effective as colloid for volume supports U/O better less side effects inexpensive
39
Benefits of colloids
better at restoring severe volume deficits longer half life better for low protein less tissue edema
40
Blood therapy indication
Mainly to increase oxygen carrying capacity
41
ASA 2006 guidelines for blood transfusion
rarely indicated for Hgb > 10 always indicated for Hgb < 6 use of trigger not recommended when appropriate use autologous blood, cell saver, normovolemic dilution
42
Normovolemic dilution
giving large volume before case to prevent loss of RBCs
43
Blood administration risks
Hep B, C, HIV, Sepsis, allergic reaction, lung injury, hemolytic reaction, pulm edema
44
PRBC type, Hct, toxicities
ABO Rh factor, 70% Hct, citrate toxicity - hypocalcemia
45
Autologous Blood requirement, risks
pt's own blood, must have Hgb 11 to give | human error, infection
46
Platelet indication, volume, increased count, risk
<50k, 200-250 ml volume increases count 7-10k bacterial risk (not stored cold)
47
FFP indications, requirement, risk, increased count
``` replaces all coag factors except platelets must be ABO compatible reverses warfarin give after multiple PRBCs risk: acute lung injury 2-3% increased clotting factors per unit ```
48
Cryo components, administration
factor VII, XIII, fibrinogen, von Willebrands | quickly give 200ml/hr