7. Volume therapy Flashcards
How much blood can you loose and survive w/o fluid substitution?
30%
Considerations to take into account when choosing fluid therapy
1) Fluid compartments
2) Starling forces: hydrostatic + osmotic forces
3) Osmotic pressure
4) Oncotic pressure
Where will IV fluids go if glycocalyx is injured
Interstitial space (regardless of composition of IV fluid)
What are crystalloid solutions?
- A group of solutions containing water-soluble molecules (e.g., saline, dextrose solution)
- Increase intravascular volume
Types of crystalloid solutions
1) Hypotonic:
- 5% dextrose (packed as iso, becomes hypo in body)
- 0,45% NaCL
2) Isotonic:
- Normal saline (0,9% NaCl)
- Ringer-lactate
- Ringer
3) Hypertonic:
- 3% saline (NaCl) -> for hypoNa
- 7,5% saline -> for resuscitation
What are colloid solutions?
- A high molecular weight substance
- Mostly remains confined to the intravascular compartment and thus generates oncotic pressure
Types of colloids
1) Natural
- Human albumin
- Plasma protein fraction
- Fresh frozen plasma
- Ig solutions
2) Artificial
- Gelatin
- HES (limited indication)
- Dextrans (not in Hungary)
Indications for human albumin
Sepsis: If volume resuscitation with crystalloids is not sufficient
Indication for gelatin
Sepsis
When should HES be avoided?
In sepsis
If glycocalyx is injured and large volumes is needed for fluid therapy - what do we use?
Crystalloids and colloids (albumin or gelatin - not HES)
Haemostasis monitoring (static): plt count and function
1) Plt count (>5x10^9 spon. bleeding is rare)
2) Bleeding time
3) PFA-100 (time needed until obstruction of collagen/epi or collagen/ADP covered membrane pores)
Haemostasis monitoring (static): coagulation
1) PT time - INR: II, V, VII, X, fibrinogen
2) aPTT: VIII, IX, XI, XII
3) TT (thrombin time)
4) Plasma fibrinogen
5) D-dimer
Complications of blood transfusion
1) Infections
2) Hemolytic reactions
3) TRALI (transfusion associated lung injury)
4) Anaphylaxis
