Fluids, electrolytes, and acid-base 5

Question 1

Which area of the Starling curve BEST correlates with preload dependence?
a. ascending limb
b. plateau
c. descending limb
d. unable to determine

Answer 1

a. ascending limb

Question 2

Traditional fluid management consists of four components:

Answer 2

fluid maintenance
replacing the fluid deficit
replacing “third space” loss
replacing blood loss

Question 3

What rule can be used to calculate maintenance fluids

Answer 3

4:2:1

Question 4

________________ attempts to optimize the patient’s position on the Starling curve, where optimizing oxygen delivery is the fundamental objective.

Answer 4

Goal-directed fluid therapy

Question 5

A key principle of goal-directed fluid therapy is the administration of

Answer 5

small quantities of fluid (~200-250 mL) to determine the difference between preload dependence and preload independence

Question 6

Very minimal surgical trauma should be replaced with

Answer 6

1-2 mL/kg/hr

Question 7

Minimal surgical trauma should be replaced with

Answer 7

2-4 mL/kg/hr (ex. inguinal hernia repair)

Question 8

Moderate surgical trauma should be replaced with

Answer 8

4-6 mL/kg/hr (ex. major nonabdominal surgery)

Question 9

Severe surgical trauma should be replaced with

Answer 9

6-8 mL/kg/hr (ex. major abdominal surgery)

Question 10

Why is urine no longer a reliable measure of fluid status?

Answer 10

ADH reduces the kidney’s ability to eliminate fluid

Question 11

The plateau of the Starling curve is known as

Answer 11

Preload independence; because there is an optimal balance between circulating volume & myocardial performance

Question 12

Identify the components of the ERAS program that are believed to improve postsurgical outcomes (select 2).
a. isoflurane instead of desflurane
b. insertion of a nasogastric tube
c. carbohydrate drink two hours before surgery
d. avoidance of premedication

Answer 12

c. carbohydrate drink two hours before surgery
d. avoidance of premedication

Question 13

The primary objective of ERAS is to enhance postsurgical outcomes, which is accomplished through techniques that

Answer 13

attenuate the physiologic changes that accompany surgical trauma
minimize the impact of fluid shifts
maximize the nutritional impact of healing
improve postoperative pain so patients can recover faster
improve patient education and compliance

Question 14

Preoperative ERAS suggestions include

Answer 14

preadmission counseling
fluid & carbohydrate loading
fasting (2 hrs. fluids & 6 hrs. solids)
antibiotic prophylaxis
avoidance of premedication
no (or highly selective) use of bowel prep
thromboprophylaxis

Question 15

Intraoperative ERAS suggestion include

Answer 15

mid-thoracic epidural anesthesia
select short-acting drugs
goal-directed fluid therapy
normothermia
PONV prophylaxis
not using surgical drains

Question 16

Postoperative ERAS suggestions include

Answer 16

mid-thoracic epidural anesthesia
opioid-sparing analgesia
judicious fluid administration
PONV prophylaxis
not using NGT/OGT
encouraging gut motility
early oral intake
early ambulation
early removal of urinary catheter