A & E understanding

Question 1

What is colloid osmotic pressure?

Answer 1

This is the pressure exerted by plasma proteins such as albumin, that reduces fluid loss to the interstitial fluid as it draws what intravascularly into the lumen of capillaries.

Question 2

What does ‘Jv’ stand for in terms of fluid resus?

Answer 2

it refers to ‘solvent filtration’ (of fluid leaving the intravascular compartment)

Question 3

In the Revised Starling principle, what does “at supr-anormal capillary pressure, net filtration increases ISF volume” actually mean?

Answer 3

When the pressure inside the capillaires (intravascular pressure of the plasma/ glycocalyx/ cells) is higher than usual - and the colloid osmotic pressure is maximal - the Jv will then equal the net difference in pressures across the endothelium.

Question 4

In the Revised Starling principle, what does
“Raising plasma colloid osmotic pressure with hyper osmotic colloid solutions” mean for the actual (interstitial) oedema?

Answer 4

When the pressure exerted (colloid osmotic) is high, the Jv is reduced but this does not necessarily mean that there will be sustained absorption of ISF (due to eg. glycocalyx pressure) - and so it will not treat oedema.

Question 5

What is the composition of normal plasma (which is why a buffered solution is preferred for resus)

Answer 5

Na+    142
Cl-       103
K+        4.5
Mg2+    1.25
Ca2+     2.5
HCO3-    24
Glucose    0.08
Osmolality =    291

Question 6

What is the composition of 0.9% saline

Answer 6

Na+ 154
Cl- 154

Osmolality = 308

Question 7

What is the composition of 5% glucose

Answer 7

Glucose 5

Osmolality = 278

Question 8

What is the composition 0.18% saline in 4% dextrose

Answer 8

Na+ 30
Cl- 30
Glucose 4

Osmolality = 284

Question 9

What is the composition of Hartmann’s solution

Answer 9

Na+      131
Cl-         111
K+          5
Ca2+       2
HCO3- 29(as lactate)

Osmolality = 278

Question 10

What are the 5R’s in emergency medicine?

Answer 10

1 - Resuscitation
2 - Routine maintainance
3/4 - replace (add) or redistribute (decrease adjust)
5 - reassess (at least per day)

Question 11

What is the male formula for adjusting routine maintenance to ideal bodyweight?

Answer 11

56.2Kg + 1.41Kg/2.5cm over 1.5m

Question 12

What is the FEmale formula for adjusting routine maintenance to ideal bodyweight?

Answer 12

53.1Kg + 1.3Kg/2.5cm over 1.5m

Question 13

What is a dangerous amount of K+ to give in electrolyte resus?

Answer 13

Over 10mmol/ hr rapidly given is dangerous - as can provoke arrthymia