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WEEK 11 LECTURE Flashcards

1
Q

What is the whole purpose of fluid and blood management?

A

Oxygen delivery

This involves maintaining intravascular volume and managing fluid exchange.

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2
Q

What are the factors increasing surgical risks related to fluid management?

A
  • Emergency Surgery
  • Surgeries with Expected High Blood Loss
  • Long Surgeries with Large Fluid Shifts
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3
Q

List examples of high-risk surgical procedures.

A
  • Open Aortic Surgery
  • Peripheral Vascular Surgery
  • Neurosurgery
  • Thyroid Surgery
  • Prostatectomy
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4
Q

What percentage of total body water is intracellular volume (ICV)?

A

40%

Total body water is broken down into intracellular and extracellular volume.

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5
Q

What percentage of total body water is extracellular volume (ECV)?

A

20%

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6
Q

What are the components of extracellular volume?

A
  • Intravascular (Plasma) Volume
  • Interstitial (Tissue) Volume
  • Transcellular Fluids
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7
Q

What are the four components of Starling forces?

A
  • Capillary Hydrostatic Pressure
  • Interstitial Fluid Pressure
  • Plasma Oncotic Pressure
  • Interstitial Oncotic Pressure
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8
Q

What does capillary hydrostatic pressure (Pc) do?

A

Keeps blood pressure within the capillaries.

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9
Q

What is the effect of increased interstitial fluid pressure (Pif)?

A

It pushes fluid back into the capillaries (favoring absorption).

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10
Q

What is plasma oncotic pressure (πp)?

A

The osmotic pull exerted by proteins in the blood.

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11
Q

What happens to fluid movement in cases of hypoalbuminemia?

A

Fluid leaks into tissues leading to edema.

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12
Q

What does the Starling equation (Jv) represent?

A

Net fluid movement (positive means filtration, negative means absorption).

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13
Q

What is the daily fluid requirement range for adults?

A

25 to 35 mL/kg/day

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14
Q

What is the urine output threshold for oliguria?

A

< 0.5 mL/kg/hr

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15
Q

What factors can shift the Frank-Starling curve upward/leftward?

A
  • Positive inotropes
  • Sympathetic stimulation
  • Decreased afterload
  • Mild exercise
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16
Q

What are the types of intravenous fluids classified as crystalloids?

A
  • Normal Saline
  • Lactated Ringers
  • PlasmaLyte
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17
Q

What is the 4-2-1 rule for calculating fluid requirements?

A

First 10 kg: 4 ml/kg/hr; Next 10 kg: 2 ml/kg/hr; Remaining Weight: 1 ml/kg/hr

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18
Q

What are the advantages of crystalloids?

A
  • Cheaper
  • No allergenic potential
  • Easily metabolized
  • Renally cleared
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19
Q

What is a disadvantage of crystalloids?

A

Large volumes (3-4x more than colloids) are required to restore intravascular volume.

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20
Q

What are colloids?

A

Fluids containing higher-molecular-weight substances that exert osmotic pressure.

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21
Q

What is an example of a blood-derived colloid?

A
  • Albumin (5% & 25%)
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22
Q

What can excessive saline use lead to?

A

Hyperchloremic metabolic acidosis and increased risk of acute kidney injury.

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23
Q

What is the evaporative loss in surgical procedures associated with?

A

Obligatory losses of fluids other than blood due to evaporation.

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24
Q

What is the NPO fluid deficit formula?

A

NPO FLUID DEFICIT = HOURS NPO x HOUR FLUID REQUIREMENT

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25
Q

What are evaporative losses in surgical procedures?

A

Losses of fluids other than blood due to evaporation and internal redistribution of body fluids.

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26
Q

How are evaporative losses significant in surgery?

A

They are most significant with large wounds, especially burns, and are proportional to the surface area exposed and the duration of the surgical procedure.

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27
Q

What is the hourly maintenance fluid requirement for superficial trauma?

A

1 to 2 mL/kg/hr

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28
Q

What is the hourly maintenance fluid requirement for minimal trauma?

A

2 to 4 mL/kg/hr

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29
Q

What is the hourly maintenance fluid requirement for moderate trauma?

A

4 to 6 mL/kg/hr

30
Q

What is the hourly maintenance fluid requirement for severe trauma?

A

6 to 8 mL/kg/hr

31
Q

What is the NPO deficit for a 120 kg patient undergoing laparoscopic cholecystectomy for 6 hours?

A

maintenance = 160 x 6hr NPO = 960ml

32
Q

What are the consequences of inappropriate fluid administration?

A
  • Hypovolemia
  • Decreased circulating volume
  • Decreased microvascular perfusion
  • Reduced tissue perfusion
  • End-organ complications
  • PONV
  • Renal dysfunction
  • Myocardial ischemia
  • Hemoconcentration
33
Q

What is the definition of Goal Directed Fluid Therapy (GDFT)?

A

A fluid management approach that tailors fluid administration based on real-time hemodynamic variables.

34
Q

What are the goals of Goal Directed Fluid Therapy (GDFT)?

A
  • Optimize tissue oxygenation
  • Optimize perfusion
  • Prevent both over- and under-resuscitation
35
Q

What is plethysmography variability index (PVI) used for in GDFT?

A

To assess dynamic fluid responsiveness.

36
Q

What monitoring techniques are used in GDFT?

A
  • Pulse contour analysis
  • Esophageal Doppler
  • TEE/TTE
  • Dilution techniques
  • Noninvasive monitors
37
Q

What does the Allowable Blood Loss (ABL) equation help to calculate?

A

It helps to determine the maximum volume of blood that can be lost without requiring a transfusion.

38
Q

What is Estimated Blood Loss (EBL)?

A

A quicker but less accurate method of estimating blood loss compared to Quantitative Blood Loss (QBL).

39
Q

What are common techniques for estimating blood loss?

A
  • Suction canisters
  • Visual estimation (e.g., soaked sponges)
40
Q

What is the storage temperature and shelf life of Whole Blood?

A

Stored at 1–6°C for up to 35 days.

41
Q

What is the volume of Packed Red Blood Cells (PRBCs)?

A

250–350 mL

42
Q

What are the indications for administering PRBCs?

A
  • Improve oxygen-carrying capacity
  • Anemia
  • Surgical blood loss
  • Hemorrhage
43
Q

What is the shelf life of PRBCs?

A

21–42 days

44
Q

What is a key role of platelets in the body?

A

Primary hemostasis

45
Q

What are the indications for transfusing platelets?

A
  • Active bleeding
  • Prophylactic use in at-risk patients
46
Q

What is the volume and storage condition of Fresh Frozen Plasma (FFP)?

A

Volume: ~200–600 mL; Stored at –18°C for 1 year.

47
Q

What is the composition of cryoprecipitate?

A
  • Fibrinogen
  • Factor VIII
  • Factor XIII
  • vWF
  • Fibronectin
48
Q

What does Prothrombin Complex Concentrate (PCC) provide?

A

Vitamin K-dependent factor replacement.
factors II, VII, IX, & X

49
Q

What is the storage condition for platelets?

A

Stored at 20–24°C with agitation.

50
Q

What is the recommended hemoglobin level for transfusion?

A

Rarely indicated when hemoglobin is >10 g/dL and almost always indicated when <6 g/dL.

51
Q

What is the pediatric dose of PRBCs?

A

10–15 mL/kg

52
Q

What is the risk associated with bacterial contamination in platelets?

A

Risk due to room temperature storage.

53
Q

What is Prothrombin Complex Concentrate (PCC)?

A

Vitamin K-dependent factor replacement used for urgent warfarin reversal

PCC is critical in managing patients on anticoagulants who require quick reversal due to bleeding.

54
Q

What is Recombinant Factor VIIa used for?

A

Last-resort option for life-threatening bleeding; dose: 15–20 µg/kg

It is particularly useful in patients with hemophilia or those who have developed inhibitors.

55
Q

What is Fibrinogen Concentrate used for?

A

Rapid correction of hypofibrinogenemia

Hypofibrinogenemia can lead to increased bleeding risk, especially during surgical procedures.

56
Q

What does TEG/ROTEM stand for?

A

Thromboelastography / Rotational Thromboelastometry

These are tests used to assess the coagulation status and guide transfusion therapy.

57
Q

What is the main purpose of blood donor screening?

A

Evaluate medical history and screen for infectious diseases

Ensures the safety of blood transfusions for both donors and recipients.

58
Q

What infectious diseases are screened in blood donations?

A
  • Hepatitis B
  • Hepatitis C
  • Syphilis
  • HIV (anti-HIV-1 and anti-HIV-2 antibodies)

Screening for these infections is crucial to prevent transmission through blood transfusions.

59
Q

What is the purpose of leukocyte reduction in blood units?

A

Removes white cells to reduce febrile reactions, immunosuppression, and CMV transmission

This process is especially important for patients who are immunocompromised.

60
Q

What is the function of a Cell Saver Machine?

A

Collects, filters, and washes shed surgical blood for reinfusion (PRBCs only)

This process helps minimize the need for donor blood during surgeries.

61
Q

What is the role of a blood warmer during transfusions?

A

Warms blood to 37°C to prevent hypothermia

Hypothermia can lead to complications during high-volume transfusions.

62
Q

What does ANH stand for, and what is its purpose?

A

Acute Normovolemic Hemodilution; it is used to minimize blood loss during surgery

Involves removing blood and replacing it with crystalloids or colloids before surgery.

63
Q

What are antifibrinolytics and provide an example?

A

Medications that prevent the breakdown of fibrin; examples include tranexamic acid and epsilon aminocaproic acid

These are used in high-risk surgeries to reduce bleeding.

64
Q

What is the definition of hyponatremia?

A

Na⁺ < 135 mEq/L

It can lead to neurological symptoms due to cerebral edema.

65
Q

What is the treatment for hypovolemic hyponatremia?

A

Isotonic saline

This helps to restore sodium levels without causing rapid shifts.

66
Q

What are the clinical manifestations of hypernatremia?

A
  • Restlessness
  • Lethargy
  • Seizures
  • Coma

Neurological symptoms are due to cellular dehydration.

67
Q

What is the treatment approach for hyperkalemia?

A
  • Stabilize myocardium with IV calcium
  • Shift K⁺ into cells using insulin with glucose or bicarbonate
  • Remove K⁺ via diuretics or dialysis

Timely treatment is crucial to prevent life-threatening cardiac arrhythmias.

68
Q

What is hypocalcemia defined as?

A

Ionized Ca²⁺ < 4.0 mg/dL or Total Ca²⁺ < 8.5 mg/dL

Symptoms may include tetany and seizures due to neuromuscular excitability.

69
Q

What is the recommended treatment for acute hypocalcemia?

A

IV calcium (chloride or gluconate)

Intravenous administration is preferred for symptomatic cases.

70
Q

What are the causes of hypercalcemia?

A
  • Hyperparathyroidism
  • Malignancy
  • Granulomatous disease
  • Immobilization
  • Milk-alkali syndrome

Identifying the underlying cause is essential for effective treatment.

71
Q

What is the initial treatment for significant hypercalcemia?

A

IV saline hydration followed by loop diuretics

This helps to promote calciuresis and reduce calcium levels.

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