chapter 23, 24 notes

Question 1

preoperative fluid balance

Answer 1

adh released during surgery curtails the ability of the kidneys to remove excess fluid

patients are replaced during surgery to compensate for surgical losses as well as hourly fluid requirements

third spacing- lack of fluid in the extracellular space- going to a third space.

Question 2

crystalloids

Answer 2

cross rapidly from the vascular to the interstitial spaces (gut, lungs, dependent parts)

ONLY 1/3 REMAIN INTRAVASCULAR

Question 3

Balanced salt solutions

Answer 3

LR, plasma-lyte, normosol

lactate is metabolized to generate bicarbonate

Question 4

fluids to be used with blood

Answer 4

saline or plasma lyte

Question 5

normal saline

Answer 5

dose dependent- hyperchloremic metabolic acidosis, and need for renal replacement therapy

Question 6

hypertonic saline

Answer 6

used to control intracranial hypertension or rapid intravascular resuscitation

Question 7

5% dextrose

Answer 7

similar to free water as dextrose is metabolized- not commonly seen in the or as hyperglycemia is associated with poor outcomes and the stress of the operative period causes blood sugar levels to increase

Question 8

albumin

Answer 8

5%-25% solution compromised of 50% plasma proteins it remains in the intravascular space longer than crystalloids.

Question 9

dextran 40&70

Answer 9

reduce factor VIII-Ag von willebrand factor. and hence platelet function.

potent osmotic agent used to treat hypovolemia. degraded to glucose increased bleeding times and noncardiogenic pulmonary edema.

Question 10

hydroxyethyl starch

Answer 10

interferes with von willebrand factor VIII and platelet function. most common complication is pruritus. black box- do not use in ICU or sepsis

Question 11

crystalloids versus colloids

Answer 11

SAFE (surviving sepsis campaign) stated crystalloids initially albumin when patient requires substantial amounts of crystalloids- yet one study stated mortality was higher with albumin.

Question 12

young women with short gynelocigcal surgery

Answer 12

20-30ml/kg associated with less nausea and vomiting and improved pain control

Question 13

maintenance fluid formula

Answer 13

first 10kg- 4ml/kg
second 10 gets 2ml/kg
each kg after gets 1ml/kg

Question 14

three theories of fluid need

Answer 14

surface area can estimate water expenditure

calorie need depend on age, weight, activity, and food

urinary output and insensible losses correspond to age

Question 15

d5 1/2 normal saline

Answer 15

hypertonic 432

Question 16

d5ns

Answer 16

hypertonic 586

Question 17

lr

Answer 17

iso 273

Question 18

d5LR

Answer 18

hypertonic 525

Question 19

1/2 ns

Answer 19

hypotonic 154

Question 20

3% saline

Answer 20

hypertonic 1026

Question 21

5% saline

Answer 21

hypertonic 1710

Question 22

7.5% saline

Answer 22

hypertonic 1786

Question 23

plasmalyte

Answer 23

isotonic 294

Question 24

blood storage

Answer 24

some specialities require “younger blood” less than 14 days old to be transfused. yet there is not sufficient data to state that blood storage duration has an increased mortality rate.

Question 25

monitoring for blood loss

Answer 25

gauze, floor, pockets on the drapes, suction containers, also accounting for the fluid to wash out wound.

Question 26

monitoring for inadequate perfusion

Answer 26

cvp, bp, urine, tachycardia, arterial ph will decrease only when tissue hypo perfusion becomes severe.

Question 27

blood administration

Answer 27

treat anemia with iron and erythropoietin preop. only give when absolutely necessary. hgb less than 6 almost always require blood transfusion. conditions such as cad, lung disease, surgery associated with large blood loss may warrant transfusion at a higher threshold.

Question 28

decision to administer

Answer 28

based on measured blood loss and inadequate oxygen carrying capacity

Question 29

platelets

Answer 29

during surgery platelet are not required unless the count is less than 50,000cells/mm

Question 30

platelet related sepsis

Answer 30

1:5000 if fever develops 4-6hrs after transfusion treat for sepsis stored at 20-24C and account for greater degree of bacteria growth.

Question 31

ffp-

Answer 31

reversal of warfarin and management of heparin resistance

Question 32

cryoprecipitate

Answer 32

treating hemophillia

Question 33

leading causes of a fatal outcomes from blood tranfusions

Answer 33

TRALI | TACO

Question 34

TRALI

Answer 34

lung injury to include pulmonary edema, arterial hypoxemia, dyspnea. less often in blood less than 14 days in storage and exclusion of female donors.

Question 35

citrate

Answer 35

hypocalcemia is seen in liver transplant patients or patient receiving mass transfusion

Question 36

febrile reactions

Answer 36

1% occurrence. interaction between recipient antibodies and antigens present on the leukocytes or platelet of the donor. slow infusion and administer antipyretics. temp doesn't increase above 38

Question 37

D5%

Answer 37

hypotonic 253

Question 38

ns

Answer 38

iso 308

Question 39

d51/4ns

Answer 39

iso 355