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Anesthesiology > Required Reading-Fluids/Intraop Complications > Flashcards

Required Reading-Fluids/Intraop Complications Flashcards

1
Q

Total body water is _____ of body weight. Intracellular is ___ and extracellular (interstitial fluid and plasma) is ____.

A

60%; 40%; 20%

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2
Q

Extracellular to intracellular shift of fluids cause dramatic illnesses, such as ____ of cells, swelling of ______ and ____.

A

lysis; brain/SC; renal failure

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3
Q

If 70kg man, TBW is ____, intracellular water is ____ and extracellular water is ____.

A

42L; 28L; 14L

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4
Q

Extracellular fluid consists of ____ (16% TBWt) and ____ (4% TBWt)

A

interstitial fluid (~11.2L); plasma (~2.8L)

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5
Q

RBCV + plasma volume is ___ liters, or the total blood volume

A

2L + ~3L = 5L

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6
Q

CO is about ____ per minute

A

5L

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7
Q

Transfusing blood products adds volume to BOTH ____ and ___ space.

A

extracellular; intracellular (RBCV)

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8
Q

Fluids are to support ___ of heart, avoid excessive expansion of ____ space, allow some ____ fluid to be transported back into intravascular space, and avoid changing ____ space (specifically in neurons)

A

preload; interstitial; interstitial; intracellular

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9
Q

Clinical var to assess intravascular volume status include:

A

skin turgor, neck veins, SBP, var of BP w/ respiration, CVP, HR, UO, hypoTN w/ anesthesia, orthostasis, base excess or HCO3

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10
Q

An increase in variability of BP w/ respiration indicates ___ intravascular volume status.

A

hypovolemic

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11
Q

A CVP between ____ indicates normal intravascular volume status.

A

8-12mmHg

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12
Q

Base excess less than -2 or HCO3 mEq/L less than 22 indicates ___ intravascular volume status.

A

hypovolemic

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13
Q

Pts kept deliberately hypovolemic are those with elevated ____ pressures, ____ pts, or after ____ surgeries.

A

pulmonary artery; COPD; thoracic

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14
Q

Crystalloids, like NS, LR (contains Ca+, K+, lactate), normosol-R mostly diffuse into ____ space and is for mostly minor procedures.

A

intracellular

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15
Q

Colloids are derived from human serum protein macromolecules like ____, or carb macromol like ___.

A

albumin/Plasmanate; Hetastarch

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16
Q

B/c oncotic pressure, macromol in colloids allows them to remain in ____ longer (hrs-days) than crystalloids (min-hrs)

A

intravascular space [minimize wt gain/edema]

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17
Q

Albumin 5% used for ____ replacement. If not diluted with NS (as opposed to 1/2NS), can cause fatal ____.

A

volume; hemolysis

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18
Q

Plasmanate contains 88% albumin and also alpha/beta/gamma ____; considered to be ______ therefore not given to Jehovah’s Witnesses. Diluted w/ NS.

A

globulins; blood product

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19
Q

Hetastarch derived from ____ and not a blood product; also less expensive than protein-derivatives

A

vegetable matter [complex carbs]

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20
Q

Calculating periop fluids: (1) Maintenance fluids (2) NPO (3) EBL (4) “third-space” loss

A

(1) 4 + 2 + 1 rule = 100ml/hr for first 60kg + 1ml/hr*remaining kg
(2) 8h x (maint. fluids) [give in first 2hrs] (3) 3 x EBL (4) minor 1-3ml/kg/h, laparoscopy 3-6ml/kg/h, exlap 6-10ml/kg/h

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21
Q

Estimate periop fluids for 100kg man who hasn’t eaten for 8 hrs, EBL about 100ml for 2h lap chole.

A

(1) Maintenance fluids = 140ml/h (2) NPO = 1220ml (3) EBL = 300ml (4) “third-space” loss = 500ml/h; Total = 2700 ml/h LR over 2h periop period

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22
Q

MC use for D5W

A

withdrawing alcoholic pts from becoming hypoglycemic

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23
Q

MC use D51/2NS + 30mEq KCL/l

A

classic maintenance fluid for medicine on ward (insensible losses)

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24
Q

MC use NS; MC problem

A

replacement for initial resuscitation for dehydration and blood loss; may cause metabolic acidosis

25
Q

MC use LR; MC problems (3)

A

replacement periop losses; (1) calcium makes incompatible w/ blood products and (2) liver dz pts may not tolerate lactate (impaired gluconeogenesis) (3) hyperkalemia

26
Q

MC use Normosol

A

cardiac/renal/hepatic transplant b/c no lactate load

27
Q

MC fluids where losses exceed 2L

A

Hetastarch, Albumin/Plasmanate [also if edema and hypoalbuminemia]

28
Q

MC prob Hetastarch

A

may induce coaggulopathy if >2L given; inhibits vWF

29
Q

ABG measures these 4 values

A

pH, PaCO2, PaO2, HCO3- [base excess is derivative calculation]

30
Q

In addition to ABG, also know ___ to know quality of O2 delivery and ___ to know if there are compensatory mechanisms working

A

inspired O2 (FiO2); anion gap = serum Na+ – [Cl- + HCO3-]….nml 12-20mEq/L

31
Q

Respiratory acidosis MCCs: [remember dec excretion of CO2 and inc prod CO2]

A

hypoventilation (dec minute ventilation), obstruction sm airways, COPD, asthma, OD EtOH, sedatives, opioids, myasthenia gravis, hyperthermia, overfeeding [overprod CO2]

32
Q

Metabolic acidosis MCCs w/ anion gap

A

lactic acidosis/ethanol in blood: MUDPILES–methanol, uremia, DKA, phenytoin/propylene glycol, INH, lactate, ethylene glycol, salicylates

33
Q

Metabolic acidosis MCCs w/ NO anion gap:

A

hyperchloremic acidosis–diarrhea, NaCl solns (surgery or s/p blood loss), acetazolamide, renal tubular acidosis

34
Q

Respiratory alkalosis MCCs:

A

hyperventilation, hypothermia, muscle relaxation from NONDEPOL NMBs, anxiety from CNS lesion, altitude, pregnancy

35
Q

Metabolic alkalosis MCCs

A

vomiting, diuretics (furosemide), antacids, hyperaldosteronism

36
Q

MC problems metabolic alkalosis; Tx

A

arrhythmias, cerebral vasoconstriction, coronary vasoconstriction, can also cause retention CO2 in blood; NS +/- KCl, dilue HCl, acetazolamide

37
Q

Chronic respiratory ACIDOSIS or ALKALOSIS calculation base excess (anion gap)

A

BE = 0.4 x (PaCO2 - 40)

38
Q

Allowable Blood Loss [ABL] formula

A

EBV x (HCTinitial – HCTfinal) / HCTinitial

39
Q

One gram of Hb is equivalent to _____ HCT percentage points. Each unit of PRBC in an adult is expected to raise HCT by ___ points.

A

3; 3

40
Q

Estimated Blood Volume (EBV) formula

A

wt (kg) x average blood volume [male abv = 75ml/kg; female = 65ml/kg]

41
Q

If EBL is greater than one liter, must place ____ monitor

A

CVP (central venous pressure)

42
Q

Pulmonary artery [PA] monitors are better at measuring ____ than CVPs.

A

volume status (can sample mixed venous blood and also can assess total O2 delivery)

43
Q

____ is given for severe coaggulopathy and Factor VIII deficiency

A

Cryoprecipitate

44
Q

Factor IX concentrate has factors ___, ___ and nontherapeutic levels of ____

A

II; X; VII

45
Q

MC transfusion rxn is Major Acute Hemolytic Reaction, which is from ___ or ___ incompatibility and due to human clerical error.

A

ABO; Rh

46
Q

In Acute Hemolytic Rxn, free Hb can damage the ____. Tx is to stop transfusion and use ___ or ____ for diuresis, as well as supportive care.

A

kidneys; mannitol; furosemide

47
Q

MC transfusion infection is ____. Least common is ____.

A

CMV; Malaria

48
Q

Delayed hemolytic transfusion rxn occurs after admin of multiple RBC transfusions, usually for ____. IgM and complement involved.

A

SCD

49
Q

Anaphylactic rxn in transfusion occurs most in pts with cases of _____

A

selective IgA deficiency

50
Q

Sxs of TRALI include ______. Supportive care and mech ventilation is needed.

A

respiratory distress, fever, non-cardio pulmonary edema, hypoTN

51
Q

TRALI due to antibodies in donor against ____ antigens in recipient [ie crossmatch compatible]. Causes pulmonary capillary leak.

A

HLA

52
Q

Use FFP for ____ bleeding, ___ drug therapy needing reversal, massive transfusion, ____ , C1 esterase inhibitor deficiencies

A

ACTIVE; warfarin; TTP

53
Q

Minor febrile non-hemolytic transfusion rxn may occur even if ____ is compatible.

A

crossmatch

54
Q

Minor febrile non-hemolytic transfusion tx is diphenhydramine, acetaminophen/ibuprofen and monitoring ____ and ___

A

vital signs; UOP

55
Q

Transfusion– ____ can be prevented with inline IV fluid warmer

A

hypothermia

56
Q

Transfusion–_____ can occur b/c PRBCs tend to lyse and release products the older they are; closer to expiration can cause increase in ion concentrations

A

hyperkalemia

57
Q

Transfusion–____ common b/c citrate anticoagulant binds; transiently can cause vaso___ and hypoTN.

A

hypocalcemia; dilation

58
Q

Treat hypocalcemia due to transfusion with either 1-2g of ____ or ____

A

calcium chloride; calcium gluconate [NOT calcium bicarb or it will precipitate]

Anesthesiology (3 decks)

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