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Anesthesia Exam 1 > Anesthesia Support Part 2 > Flashcards

Anesthesia Support Part 2 Flashcards

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1
Q

how is water volume in a patient distributed?

A
  • total water volume in patient is 60-80% of body weight
  • extracellular volume: 40%
    ^ broken up into intravascular (10%) and interstitial (30%)
  • intracellular volume: 60%
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2
Q

how do you treat dehydration?

A

crystalloids: to restore water and electrolytes to the entire extracellular space (volume)
LRS, normosol, plasmalyte, physiologic saline (0.9% NaCl)

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2
Q

dehydration assessment involves mostly ________ water volume

A

extracellular
when seeing turgor, enophthalmos etc you are assessing extracellular volume. need to keep assessing to determine if fluid therapy is adequate

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3
Q

what is the only treatment for hypovolemia?

A

blood volume restoration

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4
Q

how do you support blood volume?

A
  • crystalloids
  • colloids
  • blood products
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5
Q

how can you administer fluids?

A
  • IV
  • Intraosseous (IO)- pocket exotics or parvo puppies
  • Subcutaneous (SQ or SC)
  • Per os (PO)
  • stomach tube
  • intraperitoneal (IP)- mainly lab animals
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6
Q

what are the goals with fluid therapy?

A
  1. restore deficits
  2. maintain normal ongoing loss
  3. treat abnormal losses
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7
Q

how do you restore deficits with fluid therapy?

A

deficit determined before anesthesia from dehydration, hypovolemia and third space loss assessment
10% of body weight will determine the fluid that you will administer- but 60-8% of BW is water- so normal to overdo it, but any excess fluid the kidneys can get rid of if not given too fast

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8
Q

what causes normal ongoing loss?

A

ongoing losses typically connect to metabolic activity: cells are using water as they generate ATP.
- normal ongoing loss depends from caloric expenditure, urine and fecal production and evaporation

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8
Q

what are factors to consider if concerned about abnormal fluid loss?

A
  1. evaporation from dry anesthesia gas
  2. evaporation from open cavities
  3. blood loss
  4. third space loss
  5. diuresis
  6. diarrhea and vomiting
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9
Q

why would too much fluids be an issue?

A

causes dizziness and nausea. creates edema on tissues, wound healing is delayed and further jeapordized. edematized tissues create pressure on capillaries, so instead of increasing perfusion, youre actually decreasing perfusion

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10
Q

what is the guideline for crystalloid administration in anesthetized patients?

A

1-10mL/kg/hr
lately people just go in the middle and give 5mL/kg/hr

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11
Q

what are colloids?

A

a fluid that has a higher oncotic pressure (crystalloids/fluids have 0 oncotic pressure so will easily move into extravascular space_
colloids are used to restore blood volume and maintain oncotic pressure

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11
Q

what amounts of fluid boluses should you administer (conservative, then shock fluid)

A
  1. start with conservative: 10-20mL/kg
  2. shock fluid bolus (blood volume): 50-100mL/kg
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12
Q

why are crystalloids not ideal for a patient that is hypotensive or losing blood?

A

only 25-30% of crystalloids will remain in the intravascular space after 30-45 minutes. why really good for rehydration; putting fluids outside vasculature.
if patient is hypotensive or losing blood the crystalloids aren’t going to help with this- they cause hemodilution: PCV, proteins, platelets, coag factors. not good for an already hypotensive patient

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13
Q

how do colloids maintain oncotic pressure?

A

colloids have a higher oncotic pressure
oncotic pressure: genearted by albumin within plasma protein: attracts water into vasculature, preventing or minimizing water moving

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14
Q

what is the normal COP (colloid oncotic pressure)

A

force generated by plasma proteins to maintain water in the vasculature space:
normal: 20-22mmHg

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15
Q

what are disadvantages of colloids?

A
  1. hemodilution
  2. coagulopathies: colloids have hetastarch (starch molecule) that is very sticky and will render platelets dysfunctional. why we limit them!
  3. limit daily dose to 20mL/kg/day
  4. anaphylactic rxns (humans)
  5. fluid overload
  6. acute renal disease (don’t use, just use blood products)
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15
Q

what are advantages of using colloids?

A
  1. stays in vasculature longer! 6-48 hrs
  2. relatively economical
  3. long shelf life
  4. increase blood volume rapidly
  5. may prevent edema
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16
Q

what are common colloids used at the VTH?

A
  1. hetastarch
  2. oxyglobin (highest oncotic pressure)
  3. human and dog albumin
    dextran outside US
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17
Q

what are blood products seen at a specialty hospital?

A
  1. fresh whole blood
  2. stored whole blood
  3. stored RBC
  4. plasma
  5. platelet-rich solutions
  6. oxyglobin (purified Hgb)
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18
Q

what is blood typing?

A

identifies RBC antigens to prevent alloantibodies contact that may cause hemolytic reactions

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19
Q

what is crossmatching?

A

major and minor: detects Ig from recipient or donor that may cause hemolytic reactions
if an animal has already received a transfusion 3+ days ago, typing is meaningless. animal could have already developed an immune response on that transfusion. cross match instead

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20
Q

what is fresh whole blood?

Study These Flashcards
A

original blood (fresh) from the donor that contains RBC, platelets, proteins, coagulation factors, etc
^ most commonly seen in private practice

21
what is the only blood product that will have active platelets?
fresh whole blood
22
what is stored whole blood?
original blood from donor but preserved in the fridge. contains RBC, proteins, coag factors. need to take into consideration that platelets are starting to die
23
what is stored RBC?
concentrate of RBC and contains mainly RBC: PCV 70-80%
24
what is plasma?
plasma remnant after spinning the blood for RBC that contains proteins, coagulation factors, etc
25
what is the goal of blood separation?
having 1 donor that can treat more than 1 recipient! if you want to restore RBC, use stored RBC. if patient doesn't need RBC and just needs proteins and coag factors, then just do plasma
26
T/F: platelet-rich solutions are commonly seen in specialty hospitals
false they are concentrates of platelets in plasma or solution, and are NOT commonly used in vetmed
27
what is oxyglobin? where does it come from
oxygen-carrying fluid from bovine Hb. not available at the moment, but likely will be back CAN USE ACROSS SPECIES!
28
at what rate do you administer blood products for routine administration?
when PCV <20% or TP <3.5 administer at 1-5mL/kg/hr if patient bleeding: faster!
29
This dog (10 kg) is actively bleeding at 10 ml/kg/h. The PCV this morning was 25%. What would be his current PCV (2 hours later)? a) PCV lower than 25% as RBC are lost b) PCV around 25%, similar to before c) PCV above 25% due to splenic contraction d) Any of the above are possible
d) Any of the above are possible need to monitor and measure. if acute blood loss, now reducing O2 carrying capacity, etc. if chronically anemic or diseased, body has been compensating and is fine
30
sodium electrolyte disorders
- major component of ECF - major component for osmolality - imbalances between Na and H2O occur simultaneously - often used to estimate fluid balance - regulated by kidney via aldosterone
31
potassium electrolyte disorders
- major component of ICF - serum levels are poor reflection of total body K+ because most of it is intracellular, so what we are measuring is extracellular. body can shift it fast! - important function in excitable membranes: AP and cardiac rhythm. High K+ leads to arrhythmias and cardiac arrest - exchanges with H+ in acidosis - regulated by renal function and hydrogen ion
32
chloride electrolyte imbalance
- important in ECF - inverse relationship with bicarb - important for pH maintenance - tends to follow Na+ and improves with treatment of Na+ issues
33
calcium electrolyte disorders
- measured as total or ionized calcium - highly protein bound! 95% ^ why we measure ionized calcium: free active calcium - important for myocardial, vascular and neuromuscular function
34
magnesium electrolyte disorders
- calcium regulation - vital for CV and neuromuscular function - not commonly measured - antithrombotic and anticonvulsant - may be used to treat pain
35
phosphate electrolyte dysfunction
- essential for energy production! ATP - component of 2nd messengers - component of enzymes - important for RBC integrity - platelet integrity and function
36
when do you get calcification of tissues and organs? what 2 electrolytes cause this?
when Ca x P > 70, get predisposed to calcification
37
cations
Na+, K+ + UC (unmeasured cations)
38
anions
Cl-, HCO3-, UA (unmeasured anions)
39
anion gap
(Na+ + K+) - (Cl- - HCO3-) = UA - UC
40
normal anion gaps
dog/cat: 13-25 horse: 10-17 food animal: 14-28
41
when you have a high anion gap, what is one of your differentials?
ethylene glycol toxicity!! see extremely high anion gap
42
what are the unmeasured anions?
SO4, lactate, ketoacids, proteins, phosphates, ETHYLENE GLYCOL!!
43
if you have a high anion gap, what electrolytes are low/high?
high Na+/K+ high UA low Cl, HCO3 low UC
44
what is normal pH?
7.35-7.42 hydrogen determines the pH of the body itself
45
what is the acid/base balance equation
CO2 + H2O = H2CO3 = H+ + HCO3-
46
hypoventilation causes
hypoventilation = high CO2 causes respiratory acidosis (high H+ and low pH)
47
hyperventilation causes
hyperventilation = low CO2 causes respiratory alkalosis: low H+ and high pH
48
high bicarbonate causes
metabolic alkalosis: low H+ and high pH
49
low bicarbonate causes
high H+ and low pH
50
how do you treat respiratory acidosis or alkalosis?
correct ventilation!
51
how do you treat metabolic acidosis or alkalosis?
correct underlying disease! if emergency: give bicarbonate for acidosis physiologic saline for alkalosis if you add in NaCl saline you are adding Cl, body will decrease bicarbonate
52
causes of hypoglycemia
1. Overdose of Insulin 2. Insulinoma 3. Sepsis 4. Anorexia 5. Liver disease 6. Addison’s 7. Neoplasia 8. Idiopathic (eg. neonatal)
53
causes of hyperglycemia
1. Stress - Sepsis - Pain 2. Diabetes 3. Cushings 4. Drugs (2 agonists, guaifenesin, steroids) 5. Neoplasia (pheochromocytoma, glucagonoma) 6. Iatrogenic (dextrose administration) 7. Postprandrial 8. Acromegaly (cats) 9. Parenteral Nutrition (critically ill patients)
54
hyperglycemia predisposes to
DKA, increased osmolality, PU, PD, infections, neuropathies, cataracts, chronic pancreatitis, increased post-operative morbidity
55
Hypoglycemia Predisposes to:
Weakness, seizures, hypothermia, collapse - coma, blindness

Anesthesia Exam 1 (6 decks)

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