Limited fluid volume resuscitation

Question 1

Hammond compendium 2009; Limited fluid volume resuscitation. What two fluid products are noted to be superior to isotonic crystalloids alone for vascular volume expansion?

Answer 1

Hypertonic saline and colloids

Question 2

Hammond compendium 2009; The use of hypertonic saline and colloids for vascular volume expansion may expedite stabilization of hemodynamic parameters while reducing the risk of _________ and ________in the lungs and brain

Answer 2

Rebleeding and edema

Question 3

Cerebral and renal bloodflow are preserved at what mean arterial pressure?

Answer 3

60-70 mm Hg

Question 4

What percentage of isotonic crystalloid remains in the intravascular space after one hour?

Answer 4

<20%

Question 5

What are additional benefits of hypertonic saline?

Answer 5

Restoration of cellular function following traumatic brain injury and immune system modulation

Question 6

During hypotensive resuscitation, the patient is resuscitated to a mean arterial blood pressure of no greater than ___ millimeters of mercury?

Answer 6

60

Question 7

Limited fluid volume resuscitation should be considered in what kind of cases?

Answer 7

hemoabdomen, traumatic pulmonary contusions, traumatic brain injury, and other forms of active hemorrhage

Question 8

LFVR (limited fluid volume resuscitation) involves using the smallest volume of fluid possible to restore intravascular compartment and resolve shock while minimizing fluid extravasation into the brain and lungs and the risk of disrupting an incipient blood clot. What is the goal mean arterial blood pressure or the goal systolic blood pressure when performing LFVR?

Answer 8

MAP of 70 mm Hg or SAP of 90 mm Hg

Question 9

Total body water accounts for approximately ____% of bodyweight.

Answer 9

60-70% (guyton)

~60% (Tobias)

Question 10

Of the total body water, ____ percent is located in the intracellular space including red blood cell mass and ____ percent in the extracellular space.

Answer 10

66%

33%

Question 11

The extracellular space is subdivided into intravascular (___%) a.k.a. plasma and interstitial (___%) compartments. The intravascular space and interstitial compartment are separated by what two things? Hint: what kind of cells or membranes?

Answer 11

Intravascular equals 25% and interstitial equals 75%. Separated by endothelial cells and a basement membrane

Question 12

What is the most abundant cation in the extracellular fluid?

Answer 12

Na+

Question 13

In response to what three things do the kidneys maintain extracellular fluid sodium levels and tonicity and contribute to the maintenance of blood pressure? (Hint: think of one system, one kind of hormone, and one axis)

Answer 13

In response to the renin-angiotensin-aldosterone system, brain atrial natriuretic hormones, and the posterior pituitary-vasopressin-renal axis, the kidneys maintain extracellular fluid sodium levels and tonicity and contribute to the maintenance of blood pressure

Question 14

According to starlings law of capillary hemodynamics, fluid movement between intravascular and interstitial compartments depends on (in addition to membrane pore size) differences between what three pressures?

Answer 14

Osmotic, hydrostatic, and colloid osmotic pressure (COP)

Question 15

When hypertonic saline is used alone, the effect typically lasts less than ___ minutes. However when hypertonic saline is used in combination with colloids, the effect on volume expansion (and therefore cardiac output) is sustained for how long?

Answer 15

30 minutes, 2 to 3 hours

Question 16

Hypertonic saline and colloids can be mixed for simultaneous administration, and the rate of administration should not exceed __ mL/kg/min.

Answer 16

1

Question 17

What are the beneficial effects of hypertonic saline on the heart?

Answer 17

Increased inotropy, chronotropy, coronary bloodflow, and venous return

Question 18

With the use of hypertonic saline, increases in renal, splanchnic, and coronary bloodflow have been attributed to a decrease in _______ _________ _________ and redistribution of cardiac output.

Answer 18

Peripheral vascular resistance

Question 19

Hypertonic saline has also been shown to have what effect on leukocytes? (this effect may help to blunt the inflammatory response and activation of the coagulation cascade.

Answer 19

Decreased leukocyte adhesion and migration

Question 20

Hypertonic saline use in hemorrhagic shock also prevents immunosuppression after injury by decreasing plasma levels of what cytokine?
Also by decreasing certain prostaglandins and also by limiting what other processes? (Hint: think about effect on WBC, bacteria, and lungs)

Answer 20

Prevents immunosuppression after injury by decreasing plasma levels of interleukin-4 and certain prostaglandins and by limiting neutrophil activation, bacterial translocation, and pulmonary lesions.

Question 21

It is critical to maintain a cerebral perfusion pressure above ___ millimeters of mercury in dogs and cats. Given that CPP = MAP-ICP and that normal ICP in dogs and cats is approximately 5 to 10 mmHg, MAP must be maintained above __ millimeters mercury.

Answer 21

It is critical to maintain cerebral perfusion pressure above 70 mmHg in dogs and cats. MAP must be maintained above 80 mmHg

Question 22

With head injury, adenosine triphosphate depletion leads to retention of _________ in the intracellular space, which results in intracellular accumulation of __________ and _________ and extracellular liberation of excitatory amino acids like ________.

Answer 22

With head injury, adenosine triphosphate depletion leads to retention of sodium in the intracellular space, which results in intracellular accumulation of water and calcium and extracellular liberation of excitatory amino acids like glutamine.

Question 23

Hypertonic saline helps to increase extracellular sodium concentrations and restore gradients so that calcium is returned to the _____cellular space and glutamate to the ______cellular space, limiting secondary injury and neuronal death.

Answer 23

Calcium is returned to the extracellular space and glutamate is returned to the intracellular space

Question 24

How does hypertonic saline work to minimize vasospasm, encourage local vasodilation, and limit endothelial cell swelling and permeability?

Answer 24

By promoting micro circulatory bloodflow and improving local oxygen delivery

Question 25

Name five adverse effects of hypertonic saline administration

Answer 25

Transient hypernatremia, occasional premature ventricular contractiosn, bradyarrhythmias, temporary hypotension, and bronco constriction.

Question 26

Name six contraindications to hypertonic saline use

Answer 26

dehydration, preexisting hypernatremia, cardiac failure, hyperosmolar conditions (e.g., diabetic ketoacidosis), renal failure, and intravascular volume overload.

Question 27

What is the molecular weight of synthetic colloids?

Answer 27

69,000 Da (the weight of albumin) or greater