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Principles in Practice > Fluid and Electrolyte Management > Flashcards

Fluid and Electrolyte Management Flashcards

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1
Q

Different signs of Hypovolemia

5%, 10%, 15%

Mucus

LOC

Orthostatic [HR, BP]

UOP

PULSE RATE

A
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2
Q

Laboratory/ Monitoring evaluation for Hypervolemia

A
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3
Q

Where do you start your Fluid challenge?

A

you can always give more, never less

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4
Q

What are the most common electolyte that you will be giving?

A

Sodium

Potassium

Calcium

Magnesium

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5
Q

Percent of Intracellular and Extracellular

Fluid in the body

A

Intracellular is so much bigger than extracellular fluid

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6
Q

What electrolyte does NS have?

A

Na 154

Cl 154

Ph 4.2

mOsm/L: 308

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7
Q

What is the composition of LR

A

Na: 130

Cl: 110

K: 4

Ca: 3

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8
Q

What is the composition of Plyte?

A

Na: 140

Cl: 98

K: 5

Mg: 3

ph: 7.4

mOsm/L: 294

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9
Q

What is the goal of Hyponatremia?

What is causing the electrolyte disturbance?

A
  1. Na and water deficit
  2. Water excess
  3. Na and water excess
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10
Q

What is the level of Hyponatremia you should be worried about and you may see seizure

A

<110

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11
Q

What is the tx of hyponatremia

A
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12
Q

can you rapidly correct hyponatremia?

What is safe for GA?

A

NO!

may cause central pontine myelinolysis

>130

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13
Q

What is the goal for correction of Hyponatremia?

A

6-8 meq / l

*key is slow correction and checking your sodium levels

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14
Q

What is an EKG change that you can see for hypokalemia

A

U waves, T wave flattening, ST- segment changes

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15
Q
A
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16
Q

What are the TX of hypokalemia

A

Remember that NDMB should be reduced 25-50% since hypokalemia causes increased sensitivity.

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17
Q

What are Hyperkalamia EKG changes?

A

numbness tingling on extremities

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18
Q

What is the presentation of Hypercalcemia?

A
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19
Q

Hypocalcemia EKG changes

A

prolonged Qt

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20
Q

What is the TX OF HYPOCALCEMIA?

what other electrolyte you should follow?

A

– follow Mg

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21
Q

EKG changes for hypocalcemia and hypercalcemia

A
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22
Q

Hypercalcemia Causes

A
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23
Q

Tx of Hypomagnesemia

A
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24
Q

Hypermagnesemia

Causes

Clinical Management

25
What are the tx of **hypermagnesemia**
26
How to calculate your NPO hours?
27
**What are the EBV for** **Neonates:** **Premature:** **Full term**
28
EBV for Infantd
Infants 3-12 months 80 ml/kg
29
Adults Males Females
30
What can NaCl cause?
Hyperchloremic, hypernatremic metabolic acidosis if **\>3-4 L given**
31
How do you calculate Hct?
**Hgb x 3**
32
**How to replace blood loss?** LR/NS/Plyte: Colloids: PRBC:
33
What is the EBV formula?
34
Blood Component Therapy Why do you need whole blood for? What is the Hct? What does it contain? How much does it raise Hct?
- massive infusion therapy - 40% HCT
35
PRBC what is HCT? How much does it increase Hct? What is the volume?
Tubing should contain 170-230 mm fliter Warm it - Hypothermic effects and lower level of 2,3 DPG in stored blood cause leftward shift of oxyHgb dissociation curve Infuse NS
36
Know banked blood preservatives what does the different additives do?
37
What happens to older blood?
The older the blood the more acidotic it gets
38
When can you not give O+
pregnant women
39
What are the two things that the TEG are looking at? what does it require?
**Coagulation** **Fibrinolysis** frequent calibrations.
40
**Initiation**
**Time of latency from start of test to initial fribrin formation**
41
**Amplification**
Time taken to achieve a certain level of clot strength
42
**Alpha**
- angle (slope between R and K); measures the speed at which fibrin build up and cross linking takes place, ***hence assesses the rate of clot formation***
43
Definition: TMA MA?
**time to maximum amplitude** **Maximum amplitude -** represents the ultimate strength of the fibrin clot; i.e **overall stability of the clot**
44
Important TEG patterns
45
Important TEG form and treatment
46
Citrate Intoxication
Complications of massive blood transfusion therapy Ø **Citrate intoxication**: from the addition of CPD as preservative for stored blood; can occur with rapid transfusion (\>150ml/min) l Citrate metabolized by liver; if rate of transfusion exceeds 1 unit of blood per minute in an adult, decreased calcium may result (binds calcium and magnesium) l Due to accumulation of citrate chelating serum calcium l Pediatric patients and those with liver disease more likely to become intoxicated
47
**Symptoms of Citrate Intoxication** **and** **Treatment**
**S ymptoms of citrate intoxication** Ø Hypocalcemia Ø Hypotension Ø Increased LVEDP Ø Increased CVP Ø Prolonged QT interval Ø Hypomagnesemia l Tachyarrhythmias, TdP, refractory V Fib Treatment: Ø Calcium or magnesium Ø Citrate will be metabolized quickly in Kreb’s cycle so symptoms may abate before treatment needed
48
when do you see Dilutional coagulopathy
Ø Seen with massive transfusions \> 1 EBV Ø Microvascular bleeding Ø Hematuria Ø Bleeding at IV sites Clinically oozing Ø Increased PT/PTT Ø Decreased platelets | (\>10 units)
49
What is the tx of Dilutional coagulopathy
Treatment for dilutional coagulopathy Ø Surgically control the bleeding Ø Keep patient warm Ø Maintain perfusion and euvolemia Ø Don’t overhydrate and dilute patient Ø Consider FFP, platelets Ø Consider Vitamin K, DDAVP (enhances platelet adhesiveness)
50
Citrate combines to?
**calcium**
51
really common complication of blood transfusion
52
most commonly transfused virus in blood transfusion
CMV virus - if patient is a transplant you have to ask for it to be CMV negative and irradiated blood.
53
FFP indications? what does it contain?
54
How long can you store FFP?
can be stored for a year
55
When do you give platelets?
1 unit of platelet per 10 kg of bodyweight it has 6-7 donor units and will raise count 5 - 10
56
57
What is the normal platelet count? what is the trigger?
58
When do yo give Cryo?

Principles in Practice (19 decks)

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