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SU-18 ER > FLuids > Flashcards

FLuids Flashcards

1
Q

Reason for Fluid Resuscitation

A
  1. Restore volume lost to sustain critical organ perfusion
  2. Maintain oxygen carrying capacity for adequate cellular oxygen delivery
  3. Correct derangements in coagulation
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2
Q

Types of Fluids Used (primary volume expanders)

A

Crystalloid
Emergency release blood (O Neg)
Pts blood type

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3
Q

Lethal Triad

A

Hypothermia
Acidosis
Coagulopathy

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4
Q

why’do we care about fluid rescuitation

A

transportation of gases nutrients and wastes

generation of electrical activity for body function and health

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5
Q

volume loss patho

A

decreased volume causes stimulation of cardiac stretch and baroreceptors = lowered BP and venous return = decreased SV

stimulation of sympathetic NS = increased HR, vasoconstriction, ventricular contraction

kidneys: activate RAAS and ADH (water retention and increased thirst)

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6
Q

volume loss 2/2 hemorrhage causes

A

activation of coagulation system

platelet deposition and local medaiteors in effort o seal injury site and prevent further blood loss

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7
Q

electrolytes in intracellular space

A

potassium
magnesium

no Ca, little NA, Cl

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8
Q

extraceullar space elexttrolyes

A

Na, Cl

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9
Q

ECF composed of

A

20% of all TBW

interstitial, vascular, transcelluar

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10
Q

interstitial space

A

transport mediator

vascular compartment with cells

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11
Q

vascular compartment

A

blood

essential for transport of electrolytes, gasses, nutrients, wastes

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12
Q

interstitial fluid

A

transport vessel for electrolytes and gases, nutrients, wastes between cellular and vascular compartments

serves as reservoir

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13
Q

interstitial fluid as a reservoir

A

mucopolysaccharide gel

aids body in times of hemorrhagic and volume loss

helps try to maintain

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14
Q

transcellular compartment

A

separation of thin membrane material

fluid accumulates here when theird spacing

not available for exchange

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15
Q

4 forces of fluid transfer

A
  1. capillary filtration pressure
  2. capillary colloid osmotic pressure
  3. interstitial fluid pressure
  4. tissue colloid osmotic pressure

these forces oppose each other so that there is little fluid left in interstitial space

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16
Q

capillary filtration pressure

A

mechanical force

forces water out of capillaries and into intersitium

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17
Q

capillary colloid osmotic pressure

A

pulls water back into capillary
[osmotic pressure

generated by plasma proteins

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18
Q

interstitial fluid pressure

A

opposes movement of water OUT of capillary

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19
Q

tissue colloid osmotic pressure

A

pulls water from capillary to interstitial space

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20
Q

electrolytes

A

substance that dissociate in solution to form charged particles

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21
Q

non electrolytes

A

dont dissociate

glucose and urea

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22
Q

hypovolemia

A

any condition of EC volume reduction that causes reduction in tissue perfusion

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23
Q

absolute hypovolemia

A

volume has LEFT the body

hemorrhage, burns, vomiting, polyuria, evaporation

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24
Q

reactive hypovolemia

A

fluid is still within the body but not available

capillary leak, ascites, effusion, vasodilation

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25
sensible loss
early measured or quantified by individual or clinician
26
insensible loss
volume loss that is not easily measured or quantified
27
classic signs of hypovolemia
tachycardia HoTN poor peripheral perfusion (weak pulse, prolonged refills) AMs or ACS 2/2 poor global perfusion
28
outliers of hypovolemia s/s
intraabdominal bleed MAY cause paradoxical vagal stimulation THEREFORE present with bradycardia
29
Cushing reflex
intracranial bleed causes HTN and bradycardia (as opposed to normal hypovolemia signs)
30
IV access
large bore (NST 18 or less) 2 sites rate of infusion size and pressure matter can alter diameter and gravity
31
options other than peripheral lines
``` central lines (fem line) IO placement saphenous vein cut down ```
32
2 components of fluid therapy
replacement therapy | maintenance therapy
33
replacement fluid therapy
corrects exiting water and electrolyte deficits GI/GU dz, bleeding, thrid spacing
34
maintenance fluid thearpy
replace ongoing losses of water and electrolytes under what would be considered NORMAL conditions I.e. post op
35
crystalloid or colloid?
there is no clinical difference in survival BUT crystalloid is recommend
36
preferred agent of fluid replacement
crystalloid
37
crystalloid
low onchotic pressure = does not last substantial shift between vascular space and cellular space 3:1 rule
38
3:1 rule crystalloid
for every 1 L of fluid loss, 3L of fluid replaced
39
lactated ringer
buffering of academia increase of cytokine release hyperkalemia is a risk (caution in renal pts) increased electrolytes, lactic acidosis risk
40
normal saline
slightly hyperosmolar risk of causing hyperchloremic metabolic acidosis if gibing large volumes
41
crystalloid (LR or NS) can induce
neutrophil activation
42
MC colloid used
ALBUMIN osmotic pressure unable to go into extravascular space BUT NOT substitute for blood
43
cons of colloid
no evidence of improved outcomes compared to crystalloid more expensive if HEMORRHAGIC or SEPTIC vessels become so permeable that heven this high load is not able to stay in vessel
44
fresh frozen plasma
liquid portion of blood unconcentrated source of clotting factors independent of platelets
45
plamsa contains
``` albumin fibrinogen globulins glucose lytes hormones and CO2 ```
46
universal donor of FFP
AB
47
when do we use FFP?
correction of bleeding that is secondary to a factor deficiency urgent reversal of Coumadin (Vitamin K takes too long)
48
when do you transfuse blood?
following rapid transfusion of 2-3 L of crystalloid that had modest improvement in hemodynamics pts who initially improved then deteroiated hemodynamic instability from gross blood loss
49
goal of transfusion
PERFUSION do not transfuse just to appease lab criteria, transfuse patients that need it
50
emergency release
4:4:6 PRBCs:FFP:PLT NOT whole blood
51
massive transfusion
need of >10 u blood in 24 hrs massive hemorrhage (FFP and PLT needed) 1:1:1
52
massive transfusion in trauma bay uses this system
Belmont allows for rapid transfusion, warming no risk of air emboli can be loaded and ready in 1 minute
53
universal blood donor
O neg
54
universal platelet donor
NONE
55
crucial value of low platelet
< 50,000 1 unit of platelet = 10,000 increase in concentration
56
when do you give platelets?
part of Er or massive protocol prevention of bleeding in those with known thrombocytopenia (<10K)
57
when would you use hypertonic saline?
1. head trauma | 2. hyponatremia
58
head trauma and hypertonic saline
intracranial hemorrhage minimized risk of cerebral edema NEVER used as a volume expander 3% MC used
59
hyponatremia and hypertonic saline
3% nephrology management if pt is hyponatremic and seizing, load them with tis
60
ocygen carrying rescucitation
synthetic blood that was proposed to be used to increse O2 delivery studies showed that O2 doesnt last, causes more issues (I.e. ischemia)
61
when would you increase infusion flow rate?
burns dehydration shock DKA
62
when would you decrease infusion flow rate
CHF Kidney disease elderly patient
63
permissive HoTN
theory that you leave some HoTN to prevent hypercoaguability and allow for stronger clot formation at a lower BP
64
main takeaway of TRICC trial
do NOT transfuse someone based on H and H values instead transfuse based on those who NEED

SU-18 ER (11 decks)

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