Management of Circulation Flashcards
What is maintenance therapy with IV fluids?
replaces normal ongoing losses.
What is replacement therapy for IV fluids?
corrects any existing water and electrolyte deficits
What are good indicators for adequate perfusion?
Cognitive functioning and urine output
Types of crystalloids?
- Isotonic
- Hypotonic
- Hypertonic
What are colloids used for?
Increase volume (Volume expanders) - loss of blood or loss of plasma
Types of colloids?
- Dextran
- Plasma
- Albumin
- Hetastarch
How are colloids different than crystalloids?
- More expensive
* Do not diffuse out of vascular space as quickly
How are crystalloids classified?
By their tonicity
What is tonicity?
Concentration of electrolytes (Solutes) dissolved in the waters compared to body plasma
What type of crystalloid has the same amount of electrolytes as the plasma?
Isotonic
Types of isotonic solutions?
LR
NS
D5W (***IN water)
What type of crystalloid has more electrolytes than plasma?
Hypertonic
What do hypertonic solutions do?
causes water to shift from the extravascular spaces into the bloodstream, increasing the intravascular volume.
Complications with LR?
a) Contains Potassium, can cause hyperkalemia in renal patients
b) Patients with liver disease cannot metabolize lactate
c) Lactate is converted into bicarb by liver which with larger volumes can lead to metabolic alkalosis.
What is D5W for?
a) Fluid loss and dehydration
b) Hypernatremia
Universal blood type?
Low titer O- whole blood
NS uses?
a) Shock
b) Resuscitation
c) Fluid challenges
d) Blood transfusions
e) Metabolic alkalosis
f) Hyponatremia
g) DKA
LR uses?
a) Dehydration
b) Burns
c) GI tract fluid loss
d) Acute blood loss
e) Hypovolemia
How many attempts does it take to determine IO access instead?
3 attempts or 90 seconds
Contraindications for IO?
- Fracture/Crush injury
- Ortho surgery near site
- Previous IO attempts failed
- Infection at site
- Brittle bones
IO needle size?
16-20g
Best site for IO?
anteromedial aspect of tibia (1-3cm below tibial tuberosity)
can you develop compartment syndrome from an IO?
Yes
Other complications of IO?
Tibial fracture
Osteomyelitis
Necrosis
When do you DC an IO?
As soon a peripheral vein can be used
Longer IO is in, the more risk
Why is TXA used?
- Significant volume of blood transfusion required
Examples;
(a) Hemorrhagic Shock
(b) One or more amputations
(c) Penetrating torso trauma
(d) Evidence of sever bleeding
How does TXA help with hemorrhage control?
- DOES NOT promote new clot formation
- Helps reinforce clots that are already there
- Helps reduce blood loss from internal hemorrhage sites
When is survival benefit the greatest when giving TXA?
Within 1 hour of administration
Dosing for TXA?
1 gam in 100ml of NS or LR
** Over 10 minutes
*** No later than 3 hours
What does CRoC stand for?
Combat Ready Clamp
What does JETT stand for?
Junctional Emergency Treatment Tool
When may second infusion of TXA given?
1 gram after initial fluid resuscitation
So what exactly is TXA doing?
Keeps fibrin around longer
Complications of TXA?
Hypotension with rapid IV infusion
- Seizures
- Visual changes
Storage temp for TXA?
59-86F
What’s good about plasma?
contain ALL of your clotting factors/coagulation factors needed in the process to form fibrin strands which cement the platelet plug for clotting
All males receive what type of blood?
O pos or O neg
All females of childbearing age receive what type of blood?
O Neg ONLY
Class 3 shock?
30% blood loss
1500-2000ml of blood loss
urine output 5-15ml/hr
Class 4 shock?
> 40% of blood loss
2000ml of blood loss
Urine output negligible
* Absent radial pulse means bp systolic <80
Signs of hemolytic reactions?
1) Fever
2) Chills
3) Flank pain
4) Oozing from intravenous sites
Tx for hemolytic reactions?
aggressive hydration and diuresis (to prevent kidney damage from lysed RBC elements
Febrile non-hemolytic blood transfusion reaction?
- Fever
* Chills
Urticarial blood reaction?
Hives only
How much Benadryl is given for prophylaxis for previous allergic reaction to blood transfusion?
25-50mg
How often are vitals tracked for blood transfusion?
10-15 min
What are the lines prepared with?
NS
What is the infusion documented on?
TCCC card, SF 518 and SF 600
