Exam 4 (Fluid therapy)

Question 1

What are the parts (5) of the transcellular compartment?

Answer 1

• GI tract
• Urine
• CSF
• Joint fluid
• Aqueous humor

Question 2

What are the parts of the interstitial compartment?

Answer 2

• Lymphatics & protein- poor fluid around cells

Question 3

What is the speed solutes move at?

Answer 3

Proportional to distance squared

Question 4

What is osmosis?

Answer 4

• Semipermeable membrane separate pure water from water with solute
• Diffuses from low to high concentration

Question 5

What is osmotic pressure?

Answer 5

Pressure that resists the movement of water through osmosis

Question 6

What is the formula for osmotic pressure?

Answer 6

P= (NRT) / V
- N= # of molecules
- R= constant
- T= temperature
- V= volume

Question 7

What is osmolarity?

Answer 7

Number of active particles per Liter of solvent

Question 8

What is osmolality?

Answer 8

Number of active particles per Kilogram of Solvent

Question 9

What is the normal osmolality?

Answer 9

280 - 290 mosm

Question 10

What does a higher osmolarity refer to?

Answer 10

Higher “Pulling power”

Question 11

What makes up oncotic pressure?

Answer 11

• Albumin
• Globulins
• Fibrinogen

Question 12

Most of our daily average fluid output comes from?

Answer 12

Insensible loss (sweat, tears, breath vapor)

Question 13

What does Aldosterone regulate?

Answer 13

• Sodium & Potassium levels
• If Na⁺ & fluid drops the aldosterone is released causing Na⁺ & H₂O retention

Question 14

What do the hypothalamic osmoreceptors do?

Answer 14

Figure out osmolality vs osmolarity

Question 15

What are the acute compensators (5) for volume loss?

Answer 15

• venoconstriction
• Mobilization of venous reservoir
• Autotransfusion from ISF to plasma
• Reduced urine production
• Maintenance of cardiac output

Question 16

What does Renin do/ where does it come from?

Answer 16

• Cleaves Angiotensinogen to make Angiotensin 1
• Released from Juxtaglomerular cells

Question 17

How long does it take to restore an RBC count?

Answer 17

4 - 8 weeks

Question 18

How long does it take the RAA Axis to restore volume?

Answer 18

12 - 72 hours

Question 19

Aldosterone is released from the?

Answer 19

Adrenal cortex

Question 20

Which IV fluids have the highest & lowest osmolarity?

Answer 20

• Highest: Albumin
• Lowest: D5

Question 21

What is the most “balanced” crystalloid?

Answer 21

LR

Question 22

What are the indications for crystalloids?

Answer 22

• Replacement of free water & electrolytes
• Volume expansion

Question 23

What is the distribution of volume of crystalloids over time?

Answer 23

• After 20 mins 70% is intravascular
• After 30 mins 50% is intravascular

Question 24

What are the possible side effects of crystalloids?

Answer 24

• tissue edema
• hypercoagulability

Question 25

What are downsides of normal saline?

Answer 25

- Increases Cl⁻ & K⁺ concentrations - Late onset of diuresis - causes hyperchloremic metabolic acidosis - Increases AKI & RRT in critical care Pts

Question 26

What are the uses for 3% saline?

Answer 26

- Treats hypoosmolar hyponatremia - Treats increased ICP

Question 27

Who should not receive LR?

Answer 27

Liver impaired Pts

Question 28

Which crystalloid excretes excess water faster? How?

Answer 28

- LR > NS - Supresses ADH secretion

Question 29

Colloids do what to RBC's?

Answer 29

Inhibit RBC aggregation

Question 30

How much hydroxyethyl starch is intravascular after 90 mins?

Answer 30

70 - 80%

Question 31

What are the side effects of hydroxyethyl starch?

Answer 31

- Renal dysfunction - Coagulopathy (vWF, Factor VIII & clot strength)

Question 32

When is Dextran-40 use appropriate? - How does it work?

Answer 32

- For microvascular surgeries - Inhibits Factor VIII, vWF & Plt aggregation

Question 33

What does Dextran possibly interfere with?

Answer 33

- Cross-matching due to it coating the RBC's

Question 34

What are the signs of low intravascular volume?

Answer 34

- tachycardia - Decreased pulse pressure - Hypotension - Decreased capillary refill

Question 35

How much volume must be lost to show S/S of volume depletion?

Answer 35

25%

Question 36

How do anesthetics relate to urine output?

Answer 36

Anesthetics release stress hormones, which leads to increased volume retention. Therefore decreased urine output

Question 37

What can excessive crystalloids or colloids lead to?

Answer 37

- Edema (lungs, bowel, muscle - Increased capillary hydrostatic pressure - Reduced tissue oxygenation - poor wound healing - hypo/hyper coagulation

Question 38

What is the classic fluid therapy used for?

Answer 38

- NPO deficit - Ongoing maintenance - Anticipated surgical loss

Question 39

What is the basic formula for NPO deficit?

Answer 39

- 1st 10 Kg= 4 mL/kg/hr - 2nd 10 Kg= 2 mL/kg/hr - Each 1 Kg > 20 Kg= 1 mL/kg/hr

Question 40

How is a volume deficit replaced?

Answer 40

- 1/2 of the volume in the 1st hour of Sx - 1/4 of the volume in the 2nd hour of Sx - 1/4 of the volume in the 3rd hour of Sx

Question 41

How much blood can a saturated lap sponge hold?

Answer 41

100mL

Question 42

How much blood can a raytech hold?

Answer 42

20mL

Question 43

How much blood does a saturated 4x4 hold?

Answer 43

10mL

Question 44

What is the traditional method of replacing preoperative bleeding?

Answer 44

3 : 1 with crystalloids

Question 45

A septic Pt with a 40 degree Celcius fever, has how much deficit?

Answer 45

30%

Question 46

A bowel Prep results in how much volume deficit?

Answer 46

~ 2,000 mL

Question 47

How are the evaporative/redistribution losses calculated?

Answer 47

- Minimal: 0 - 2 mL/kg/hr - Moderate: 2 - 4 mL/kg/hr - Severe: 4 - 8 mL/kg/hr

Question 48

When is the Parkland formula used?

Answer 48

Only if 20% of TBSA has 2nd &/or 3rd degree burns

Question 49

What fluid is used in burns? - At what rate?

Answer 49

- LR - 4 mL/kg/% BSA burn (1/2 over first 8hrs & rest over 16hrs)

Question 50

What body surfaces count as 4.5%?

Answer 50

- Each arm - Front of the head (face) - Rear of the head

Question 51

What does SPV measure/look at?

Answer 51

Lowest systolic peak vs highest systolic peak

Question 52

What does SVV look at?

Answer 52

Area under the curve

Question 53

What is a normal SVV?

Answer 53

10 - 15%

Question 54

What are the Limits to SVV monitoring?

Answer 54

- Low HR/RR - Irregular heart beats - Mechanical ventilation w/ low Vt - Increased abdominal pressure - Thorax open - Spontaneous breathing