1 - IV Fluids

Question 1

Normal daily fluid intake requirement:

Answer 1

2 liters (75% from H2O, 25% extracted from food)

Question 2

Urine output (UOP) should be estimated at _____ for fluid resuscitation

Answer 2

1ml/kg/hr

Question 3

UOP should be how much per 24 hrs?

Answer 3

Approximately 1 liter

Question 4

Other sources of water loss (besides peeing)

Answer 4

600ml/24hrs

Skin (75%)

Lungs (25%)

Increases significantly with fever and critical illness

Question 5

Normal fluid loss via GI tract:

Answer 5

250ml/24hrs

Question 6

Oral rehydration solution (ORS) consists mostly of:

Answer 6

WATER - SUGAR - SALT in a standard ratio

2tbsp sugar
1/2 tsp salt
1 liter water

Question 7

Examples of patients needing IV hydration

Answer 7

Inadequate PO intake

Peri-operative patients (NPO)

Question 8

IV rehydration is ok for how long? After that, what do you do?

Answer 8

Up to one week

If needed longer, consider enteral G-tube or J-tube, total parenteral nutrition (TPN)

Question 9

LR fluid is

Answer 9

Lactated ringers

Question 10

NS fluid is

Answer 10

Normal saline (0.9% NaCl)

Question 11

P-Lyte fluid is:

Answer 11

Plasma-Lyte

Question 12

What element does LR add that NS does not have?

Answer 12

Potassium

Question 13

When is LR and NS typically used?

Answer 13

Resuscitation
Hypovolemia

Not normally used for maintenance fluids

Question 14

When is D5W used?

Answer 14

Usually as a maintenance fluid

Add 20mEq of K to prevent hypokalemia

Question 15

1 unit of packed RBC’s raises the Hgb by how much?

Answer 15

1

Question 16

How long does FFP take to thaw?

Answer 16

About a half-hour

Question 17

For which patient are platelets usually reserved?

Answer 17

Actively bleeding <50K platelet count

Question 18

1 unit of platelets raises the platelet count apprx:

Answer 18

25K

Question 19

Which type of patients will receive IV albumin:

Answer 19

Liver failure
Burns
Nephrotic syndrome

Question 20

Ratio for PRBC:FFP:PLT

Answer 20

1:1:1

Question 21

Which kind of patients might get hypertonic saline?

Answer 21

Hemorrhage (increases intravascular volume)

Head injury (increases cerebral perfusion pressure and decrease intracranial pressure)

Question 22

Hypertonic saline works by:

Answer 22

Drawing fluid into the intravascular space

Question 23

What is hetastarch and when is it used?

Answer 23

Large sugar molecule used to increase intravascular volume

Question 24

What adverse outcome is the use of hetastarch associated with?

Answer 24

Increased mortality and acute kidney injury

Question 25

What is tranexamic acid?

Answer 25

Anti-fibrinolytic agent (strengthens clot - used in trauma)

Question 26

What is DDAVP?

Answer 26

Stimulates endothelial cells to release von Willebrand Factor? (VWF)

Question 27

What’s in cryoprecipitate?

Answer 27

Factor VIII VWF Fibrinogen

Question 28

What is aminocaproic acid?

Answer 28

Anti-fibrinolytic agent (strengthens clot)

Question 29

Thromboelastrography

Answer 29

Slide 13 - chart - some cards on it later

Question 30

What is TKO or KVO

Answer 30

To keep open or keep vein open Just enough fluid running in to keep the catheter patent

Question 31

A heparin lock or saline lock, useful for:

Answer 31

Antibiotics or PRN pain meds

Question 32

Intraosseous infusion - placed (drilled) into which bones typically?

Answer 32

Femur Humerus Tibia

Question 33

What is the FAST-1?

Answer 33

Special IO placed in the sternum

Question 34

Indications for IO’s?

Answer 34

Failed IV-access attempts

Question 35

CI’s for IO’s

Answer 35

Fx in bone in which IO is placed (can lead to compartment syndrome)

Question 36

Common sites for central lines?

Answer 36

Subclavian Internal jugular Femoral

Question 37

Central lines ideal for:

Answer 37

Larger volumes of fluid More caustic medications TPN Can add transducers to directly monitor hemodynamics

Question 38

Central lines can increase risk of:

Answer 38

Pneumothorax (PTX) Hematoma Infection Cardiac injury

Question 39

How often are central lines changed out?

Answer 39

Q 5-7 days or as soon as no longer necessary

Question 40

What is the Seldinger Technique?

Answer 40

Method of central line placement

Question 41

Where is the arterial line typically placed in adults?

Answer 41

Radial artery

Question 42

What are ports used for?

Answer 42

Long-term medications (chemotherapy or antibiotics) Placed under floro or CT guidance

Question 43

What is a peripherally inserted central catheter (PICC)?

Answer 43

Very long catheter Inserted into a peripheral vein, threaded to superior vena cava

Question 44

Potential complications of PICC?

Answer 44

Infection Break Air embolus

Question 45

If patient is dehydrated and will be NPO for >12 hrs, the IV fluid maintenance rate for adults is:

Answer 45

35ml/kg/24hrs

Question 46

Maintenance IV fluids for kids:

Answer 46

0-10kg: 100ml/kg/24hrs Plus 10-20kg add: 50ml/kg/24hrs Plus >20kg add: 20ml/kg/24hrs

Question 47

Caveman method of IV fluid maintenance:

Answer 47

Bolus 1/2- 1 liter and adjust UOP to 0.5 - 1ml/kg/hr

Question 48

Signs of volume depletion:

Answer 48

Decreased skin turgor Tachycardia HOTN Oliguria

Question 49

Normal UOP for adults

Answer 49

0.5-1ml/kg/h

Question 50

Normal UOP for kids

Answer 50

1ml/kg/h

Question 51

Normal UOP for babies

Answer 51

2ml/kg/h

Question 52

In the post patient with decreased UOP, tx with:

Answer 52

IV fluid bolus

Question 53

Indication for indwelling urinary catheter (Foley)

Answer 53

Accurate I/O needed Preoperatively Prolonged immobilization with sedation Neurogenic bladder

Question 54

Complications of Foley cath?

Answer 54

UTI Urethral injury

Question 55

Describe the pulmonary artery catheter

Answer 55

Measures PA pressure directly Used to assess patient’s fluid status Balloon inflated with sterile water Floated through right heart chambers and wedges in pulmonary artery

Question 56

Normal spec-grav or urine is appx

Answer 56

1.010

Question 57

Urine spec-grav higher than _____ suggests dehydration

Answer 57

1.020

Question 58

Clinical signs suggesting fluid overload

Answer 58

``` JVD Peripheral edema S3 gallop on cardiac exam Ascites, anasarca Rales on pulmonary exam DOE ```

Question 59

What are Flotrac and Vigileo?

Answer 59

Used along with serum lactate to assess hydration status Measures 2000 data points every 20 seconds ScvO2 >70% with normal lactate = good

Question 60

Short-term total enteral nutrition (TEN)

Answer 60

Placed small bore, weighted, post-pyloric feeding tube

Question 61

Long-term TEN:

Answer 61

PEG or J-tube

Question 62

Total parenteral nutrition (TPN) is given via:

Answer 62

Central catheter

Question 63

Things to monitor with TPN

Answer 63

Daily electrolytes (inpatient) Weekly liver enzymes

Question 64

Gastric tubes are placed to:

Answer 64

Decompress the stomach

Question 65

Gastric tubes are commonly placed in patients with:

Answer 65

N/V Pre-op (ate within 6 hrs) Ileus or large obstruction

Question 66

CI’s to gastric tube:

Answer 66

Cribiform plate / basilar skull fx

Question 67

Complications of gastric tube

Answer 67

Esophageal / stomach injury Hypokalemia -> metabolic acidosis

Question 68

Feeding tube is used for:

Answer 68

Short-term feeding Small-bore, weighted, post-pyloric

Question 69

How is feeding tube placement confirmed?

Answer 69

It has a nifty radiopaque tip, visible on KUB films

Question 70

Plasma and interstitial fluid electrolyte breakdown:

Answer 70

Cations - mostly sodium, a little potassium and some other stuff Anions - mostly chloride, a little bicarb, others (for plasma, also PROTEIN anions) Only difference really between plasma and interstitial fluid is that plasma has the PROTEIN ANIONS

Question 71

Electrolyte concentrations for intracellular fluid (skeletal muscle):

Answer 71

Cation - mostly potassium, a little sodium, and others Anion - mostly phosphate, some protein anions, and others

Question 72

Peripheral parenteral nutrition vs total parenteral nutrition - access:

Answer 72

PPN can be through a normal IV TPN has to be via a central line

Question 73

Fluid with highest choride?

Answer 73

Normal saline Can exacerbate acidosis

Question 74

Most isotonic fluid?

Answer 74

P-lyte

Question 75

If patient is going to get blood products or IV ABX, which fluid?

Answer 75

Normal saline

Question 76

If pt is acidotic, which fluid do we select?

Answer 76

LR

Question 77

Crystalloid examples:

Answer 77

NS and LR Used for resuscitation

Question 78

Examples of colloids:

Answer 78

``` Whole blood RBC’s FFP PLT Albumin ```

Question 79

Which blood product has the most bang for its buck?

Answer 79

FFP

Question 80

TEG - problems with R time - give:

Answer 80

FFP

Question 81

TEG - problems with K time - give:

Answer 81

Cryoprecipitate

Question 82

TEG - problems with Alpha angle - give:

Answer 82

Cryoprecipitate

Question 83

TEG - problems with maximum amplitude - give:

Answer 83

DDAVP and/or platelets

Question 84

TEG - problems with LY30 - give:

Answer 84

TXA and/or Aminocaproic acid

Question 85

Increased hematocrit with no change in RBC’s suggests:

Answer 85

Dehydration

Question 86

Question: Does an apple a day keep the doctor away?

Answer 86

Answer: Only if you aim it well enough.