FLUIDS-AB balance Flashcards
(179 cards)
1
Q
What are 6 goals of perioperative fluid management
A
- Euvolemia
- CO (preload)
- O2-carrying capacity
- A-B balance
- Electrolyte balance
- Coagulation status
2
Q
What percentage of body weight is water
A
60% (42 L in the 70-kg standard pt)
3
Q
What percentage of total body weight are the following
Intracellular volume
Extracellular volume
A
IC vol = 40% TBW (28 L)
EC vol = 20% TBW (14 L)
4
Q
What are the 3 major ions of the intracellular fluid
A
K+
Mg++
PO4–
5
Q
What are the 4 major ions of the extracellular fluid
A
Na+
Ca++
Cl=
HCO3-
6
Q
What are the divisions of ECF and their percentage of total body water
A
Interstitial fluid = 16% or 11 L
Plasma fluid = 4% or 3 L
7
Q
How do neonates differ in total body water percentage
A
They have a higher TBW% by weight
8
Q
How do females, the obese, and the elderly differ in total body water percentage
A
They have a lower TBW% by weight
9
Q
What are 2 forces that move fluid from the capillary to the interstitial space
A
Pc = Capillary hydrostatic pressure (pushes fluid out)
pi if = interstitial oncotic pressure (pulls fluid out)
10
Q
What are 2 forces that move fluid from the interstitial space into the capillary
A
Pif = interstitial hydrostatic pressure (pushes fluid in)
pi c = capillary oncotic pressure (pulls fluid in)
11
Q
What is the equation for net filtration pressure at the capillary
A
NFP = (Pc - Pif) - (pic - piif)
12
Q
What actions occurs with the following net filtration pressures in the capillaries
NFP > 0
NFP < 0
A
NFP > 0 = fluid EXITS capillary
NFP < 0 = fluid is pulled INTO capillary
13
Q
What are 4 conditions that impair the integrity of glycocalyx in the capillary
A
- Sepsis
- Ischemia
- DM
- Major vascular surgery
14
Q
What happens when the glycocalyx is disrupted in the capillary
A
It contributes to capillary leak and accumulation of fluid and debris in the interstitial space
This reduces tissue oxygenation
15
Q
What makes up blood volume
A
The sum of plasma volume and blood cell volume
16
Q
What is the hematocrit composed of
A
The fraction of the blood volume that is occupied by erythrocytes
17
Q
What factors increase Hct
A
Increased number of RBCs (polycythemia)
Decreased plasma volume (hypovolemia)
18
Q
What factors decrease Hct
A
Decreased number of RBCs (anemia)
Increased plasma volume (hemodilution)
19
Q
What is the purpose of the lymphatic system
A
Scavenge and remove fluid, protein, bacteria, and debris from the interstitium via negative pressure
20
Q
What causes edema in relation to the lymphatic system
A
When the rate of interstitial fluid accumulation exceeds the rate of removal by the lymphatics
21
Q
How is lymph returned to circulatory system
A
Via the thoracic duct at the juncture of the internal jugular and subclavian vein
22
Q
What is the significance of the left vs right thoracic ducts and venous access
A
The ducts can be injured during venous cannulation
The left side is at greater risk of chylothorax because it is larger
23
Q
Define osmosis
A
The net movement of water across a semipermeable membrane
24
Q
What are 2 factors that affect osmosis
A
- Solute concentration determine direction of water movement
- Water moves from areas of low to high solute concentration
25
Define diffusion
the net movement of a substance from an area of higher concentration to an area of lower concentration across a fully permeable membrane (both water and solute pass)
26
Define osmotic pressure
The pressure of a solution against a semipermeable membrane that prevents water from diffusing across that membrane
27
What is osmotic pressure a function of
The number of osmotically active particles in a solution NOT their molecular weights
28
What is an osmole
The number of osmotically active particles in a solution
29
How are osmolarity and osmolality similar
They both measure the concentration of particles (osmoles) in a solution
30
What is osmolarity
Osmoles per liter of solution (mOsm/L of total solution)
31
What is osmolality
Osmoles per kilogram of solvent (mOsm/kg of H2O)
32
What is the equation for plasma osmolarity
Osmolarity = 2(Na+) + (glucose/18) + (BUN/2.8)
33
What factors are included in the calculation of plasma osmolarity
Na+
Glucose
BUN
34
List solutions that are hypotonic
NaCl 0.45%
| D5W
35
What is the effect of hypotonic solutions
Water enters and cells swell
36
List crystalloids that are isotonic
NaCl 0.9%
LR
Plasmalyte A
37
List colloids that are isotonic
Albumin 5%
Voluven 6%
Hespan 6%
38
List crystalloids that are hypertonic
NaCl 3%
D5 NaCl 0.9%
D5 NaCl 0.45%
D5 LR
39
Which colloid is a hypertonic solution
Dextran 10%
40
What is the effect of hypertonic solutions
Water moves out of cells and they shrink
41
Why is D5W a hypotonic solution
The glucose is metabolized to CO2 and H2O adding to free water
42
How does administration of hypotonic solutions affect ICF, ECF, and osmolarity
```
ICF = volume increase, osmolarity decreased
ECF = volume increased, osmolarity decreased
```
43
How does administration of isotonic solutions affect ICF, ECF, and osmolarity
```
ICF = volume and osmolarity remain the same
ECF = volume increase, osmolarity same
```
44
How does administration of hypertonic solutions affect ICF, ECF, and osmolarity
```
ICF = decreased volume, increased osmolarity
ECF = increased volume, increased osmolarity
```
45
What are the benefits of dextran 40 on blood viscosity
It reduces viscosity and improves microcirculatory flow in vascular surgery
46
What effect does albumin have on inflammation
It has anti-inflammatory properties
47
What is the replacement ratio of crystalloid vs colloid
```
Crystalloid = 3:1
Colloid = 1:1
```
48
What is a disadvantage of albumin
It binds with Ca++ and can lead to hypocalcemia
49
What is the FDA black box warning for synthetic colloids
Risk of renal injury
50
How can coagulopathy related to colloids be minimized
Don't exceed 20 mL/kg
51
Which colloids have the greatest risk of coagulopathy
Dextran > hetastarch > hextend
52
Which colloid has the greatest anaphylactic potential
Dextran
53
What are disadvantages of fluid replacement with crystalloids
1. Limited ability to expand plasma volume
2. Higher potential for peripheral edema
3. Dilutional effect on coagulation factors
54
What imbalance can occur with large volumes of NaCl
Hyperchloremic metabolic acidosis
| Increased Cl- => Increased HCO3- excretion by kidneys
55
What is the most abundant intracellular cation
Potassium
56
What is the role of potassium as an intracellular cation
1. Regulates resting membrane potential of nervous tissue, skeletal muscle, and cardiac muscle
57
How does hypo vs hyperkalemia affect membrane potentials
Hypokalemia = hyperpolarizes membranes, making it harder to depolarize
Hyperkalemia = increases resting membrane potential, making depolarization easier
58
Which organ regulates potassium homeostasis
The kidneys
59
What 5 medications and conditions can shift K+ intracellularly causing hypokalemia
1. Insulin + D50
2. Hyperventilation
3. HCO3
4. Beta-2 agonist (albuterol)
5. Hypokalemic periodic paralysis
60
What 4 medications or conditions can shift K+ extracellularly causing hyperkalemia
1. Acidosis
2. Succinylcholine
3. Beta-blockers
4. Hyperkalemic periodic paralysis
61
What are 3 drugs that can impair potassium excretion from the kidneys
1. NSAIDs
2. Spironolactone
3. Triamterene
62
What are symptoms of hypokalemia
Skeletal muscle cramps and weakness that can lead to paralysis
63
How can hyperkalemia present
Cardiac rhythm disturbances
64
Describe the EKG changes with hypokalemia
PR interval = LONG
QT interval = LONG
T wave = FLAT
U wave present
65
Describe the EKG changes with hyperkalemia
```
EKG change = K+ concentration:
Peaked T waves = 5.5-6.5
P wave flattening, PR prolongation = 6.5-7.5
QRS prolongation = 7.0-8.0
QRS-> sine wave -> VF = >8.5
```
66
How is hyperkalemia treated (8)
Cardiac membrane stabilization:
Calcium
Redistribution (shift intracellularly)
- Insulin + D50
- Hyperventilation
- HCO3
- Beta-2 agonist (albuterol)
Elimination:
- K+ wasting diuretics
- Kayexalate
- Dialysis
67
What are 5 ways potassium is lost via the GI tract
1. Vomiting/diarrhea
2. NGT suction
3. Zollinger-Ellison syndrome
4. Jejunoileal bypass
5. Kayexalate
68
What is the most abundant extracellular cation and primary determinant of serum osmolarity
Sodium
69
3 ways that sodium homeostasis maintained
1. Glomerular filtration rate
2. Renin-angiotensin-aldosterone system
3. Anti-natriuretic peptides (BNP)
70
To determine the cause of hypo/hypernatremia, what else must be evaluated
1. Plasma osmolarity
| 2. ECF volume
71
Which ion is most important during neural tissue and muscle cell depolarization
Sodium
72
What are 3 causes of hyponatremia related to decreased total body Na+ content
1. Diuretics
2. Salt-wasting dz
3. Hypoaldosteronism
73
What are 4 causes of hyponatremia related to normal total Na+ content
1. SIADH
2. Hypothyroidism
3. Water intoxication
4. Perioperative stress
74
What are 2 causes of hyponatremia related to increased total Na+ content
1. CHF
| 2. Cirrhosis
75
What are 3 causes of hypernatremia related to decreased total Na+ content
1. Osmotic diuresis
2. N/V
3. Adrenal insufficiency
76
What are 3 causes of hypernatremia related to normal total Na+ content
1. Diabetes insipidus
2. Renal failure
3. Diuretics
77
What are 2 causes of hypernatremia related to increased total Na+ content
1. Hyperaldosteronism
| 2. Increased Na+ intake (3% Na+)
78
```
What are signs and symptoms of hyponatremia for the following Na+ concentrations
130-135=
125-129=
115-124=
<115=
```
```
130-135= no s/sx
125-129= N/V, malaise
115-124= HA, lethargy, altered LOC
<115= Sz, coma, cerebral edema, respiratory arrest
```
79
```
What are the signs and symptoms of hypernatremia based on the following serum osmolalities
350-375=
376-400=
401-430=
>431=
```
```
350-375= HA, agitation, confusion
376-400= Weakness, tremors, ataxia
401-430= Hyperreflexia, muscle twitching
>431= Sz, coma, death
```
80
What is the goal for correcting sodium imbalance
No more than 1-2 mEq/L/hr
81
What can happen is hypo/hypernatremia are corrected too quickly
Hyponatremia = fluid shift from ICF to ECF
-Central pontine myelinolysis
Hypernatremia = fluid shift from ECF to ICF
-Cerebral edema
82
What is the distribution of calcium in the plasma
50% is ionized
40% bound to albumin
10% bound with an anion
83
What are 3 important functions of calcium
1. Second messenger system
2. Neurotransmitter release
3. Muscular contraction
84
Which portion of the cardiac muscle cell action potential is Ca++ responsible for
Phase 2
85
Which coagulation factor is Ca++
Factor IV
86
How does the acid-base status affect ionized calcium concentration and why
Acidosis = increases ionized Ca++ (b/c albumin bind H+ and displaces Ca++)
Alkalosis = decreases ionized Ca++ (b/c albumin bind Ca++ and displaces H+)
87
How does parathyroid hormone affect serum Ca++ concentration
PTH raises [Ca++]
88
What hormone reduces serum Ca++ concentration
Calcitonin
89
Describe the process by which serum Ca++ levels decrease
1. Thyroid gland releases calcitonin
2. Osteoclast activity is inhibited
3. Ca++ reabsorption in kidneys decreases
4. Ca++ levels in blood decrease
90
Describe the process by which serum Ca++ levels increase
1. Parathyroid gland releases PTH
2. Osteoclasts release Ca++ from bone
3. Ca++ is reabsorbed by kidneys
4. Ca++ absorption in small intestine increases via vitamin D synthesis
5. Ca++ level increases
91
What are 5 causes of hypocalcemia
1. Hypoparathyroidism
2. Vitamin D deficiency
3. Renal osteodystrophy
4. Pancreatitis
5. Sepsis
92
What are 5 causes of hypercalcemia
1. Hyperparathyroidism
2. Cancer
3. Thyrotoxicosis
4. Thiazide diuretics
5. Immobilization
93
What are 6 signs and symptoms of hypocalcemia
1. Muscle cramps
2. Nerve irritability
3. Laryngospasm
4. Mental status change - Sz
5. Chvostek sign
6. Trousseau sign
94
What EKG changes are present with hypocalcemia vs hypercalcemia
Hypo:
QT interval = LONG
Hyper:
QT interval = SHORT
95
What is the treatment for hypocalcemia
Calcium supplement
| Vitamin D
96
What is the treatment for hypernatremia
```
0.9% NaCl
Loop diuretic (furosemide)
```
97
What are 5 signs and symptoms of hypercalcemia
1. Nausea
2. Abd pain
3. HTN
4. Psychosis
5. Mental status change - Sz
98
Describe the relationship between Mg++ and Ca++ at the neuromuscular junction
Mg++ antagonizes Ca++ at the NMJ
99
Normal Mg++ plasma level
1. 7 - 2.4 mg/dL
| 1. 5 - 3 mEq/L
100
Normal ionized Ca++ level
* *1.16-1.32 mmol/dL**
2. 2-2.6 mEq/L
4. 65 - 5.28 mg/dL
101
Normal plasma total Ca++ level
2. 12-2.62 mmol/dL
4. 5-5.5 mEq/L
* *8.5-10.5 mg/dL**
102
Where is Mg++ reabsorbed
In the renal tubules
103
Mg++ dose for pre-eclampsia
4 g load over 10-15 minutes
| Then 1 g/hr for 24 hrs
104
How does magnesium infusion affect the neonate
Administration for >48 hrs increases the risk of neonatal respiratory depression, hotn, and lethargy d/t Mg++ ability to cross the placenta
105
What is the rational for Mg++ use in multi-modal pain treatment
The NMDA receptor antagonism of Mg++ can decrease opioid use
106
What effect can Mg++ have on the airway
Can be used to treat acute bronchospasm because it relaxes the airway smooth muscles (antagonizes Ca++)
107
In what instances can Mg++ be administered
1. Pre-eclampsia
2. Opioid-sparing technique
3. Acute bronchospasm
4. Cardiac rhythm disturbances (PVCs or torsades)
108
What are 5 possible causes of hypomagnesemia
1. Poor intake
2. Alcohol abuse
3. Diuretics
4. Critical illness
5. Associated w/ hypokalemia
109
What are 3 possible causes of hypermagnesemia
1. Excessive administration
2. Renal failure
3. Adrenal insufficiency
110
What are 3 symptoms of slightly low magnesium
1. Neuromuscular irritability
2. Hypokalemia
3. Hypocalcemia
111
What are 3 symptoms of very low magnesium
1. Tetany
2. Sz
3. Dysrhythmias
112
What are 4 symptoms of mildly elevated magnesium
1. Diminished DTRs
2. Lethargy/drowsiness
3. flushing
4. N/V
113
What are 4 symptoms of moderately elevated magnesium
1. Loss of DTRs
2. HoTN
3. EKG changes
4. Somnolence
114
What are 5 symptoms of extremely elevated magnesium
1. Respiratory depression
2. Complete heart block
3. Cardiac arrest
4. Coma
5. Paralysis
115
How can magnesium levels affect neuromuscular blockade
Hypermagnesemia can potentiate succinylcholine and nondepolarizers
116
What does the Henderson-Hasselbalch equation represent
That a solutions pH is a function of the ratio of dissociated anions (HCO3-) to non-dissociated acid (CO2)
117
How does the blood aid in acid-base buffering
1. Bicarbonate buffer
| 2. Hgb (binds to H+)
118
How does the respiratory system act as a buffer during acid-base imbalance
By altering ventilation to change PaCO2
119
Describe 3 renal compensatory mechanisms that buffer during acid-base imbalance
1. Reabsorption of filtered HCO3
2. Removal of titratable acids (non-volatile)
3. Formation of ammonia
120
How can the intracellular fluid assist with buffering during an acid-base imbalance
By exchanging H+ into cells and K+ out of cell
121
Equation to calculate anion gap
A Gap = Na - (Cl + HCO3)
122
What are causes of metabolic acidosis with an increased anion gap
MUDPILES
1. Methanol
2. Uremia
3. DKA
4. Paraldehyde
5. Isoniazid
6. Lactate (dec DO2, sepsis, cyanide poisoning)
7. Ethanol, ethylene glycol
8. Salicylates
123
What are causes of metabolic acidosis with a normal anion gap
1. Hypoaldosteronism
2. Acetazolamide
3. Renal tubular acidosis
4. Diarrhea
5. Ureterosigmoid fistula
6. Pancreatic fistula
124
What is the difference between full and partial A-B imbalance compensation
```
Full = pH is restored to normal (but CO2 and HCO3 are abnormal)
Partial = pH is moving towards normal
```
125
What are 4 cardiac effects of acidosis
1. increased P50
2. increased SNS tone
3. Risk of dysrhythmias
4. Decreased contractility
126
What are 3 cardiac effects of alkalosis
1. Decreased P50
2. Decreased coronary blood flow
3. Risk of dysrhythmias
127
What are 2 CNS effects of acidosis
1. Increased cerebral BF
| 2. Increased ICP
128
What are 2 CNS effects of alkalosis
1. Decreased cerebral BF
| 2. Decreased ICP
129
What is a pulmonary effect of acidosis
Increased PVR (inc CO2)
130
What is a pulmonary effect of alkalosis
Decreased PVR (low CO2)
131
How does acidosis affect potassium
Can lead to hyperkalemia
132
How does alkalosis affect potassium and calcium
Hypokalemia
| Low iCalcium
133
What are 3 etiologies for respiratory acidosis
1. Increased CO2 production
2. Decreased CO2 elimination
3. Rebreathing
134
At what pH is mechanical ventilation indicated
pH < 7.20
135
What are 7 causes of hypercapnia r/t increased CO2 production
1. Sepsis
2. Overfeeding
3. Malignant hyperthermia
4. Intense shivering
5. Prolonged Sz
6. Thyroid storm
7. Burns
136
What are 8 causes of hypercapnia r/t decreased CO2 elimination
1. Airway obstruction
2. Increased DS
3. Increased Vd/Vt
4. ARDS
5. COPD
6. Respiratory center depression
7. Drug OD
8. Inadequate NMB reversal
137
What are 2 causes of hypercapnia r/t rebreathing
1. Incompetent unidirectional valve
| 2. Exhausted soda lime
138
How does a change in PaCO2 affect pH in acute respiratory acidosis
For every 10 mmHg PaCO2 increase => pH decrease 0.08
139
How does a change in PaCO2 affect pH in chronic respiratory acidosis
For every 10 mmHg PaCO2 increase => pH decrease 0.03
140
How does the body compensate for respiratory acidosis
The kidneys excrete H+ and conserve HCO3
| Full compensation can take days
141
How does respiratory acidosis lead to hypoxemia
Increasing alveolar CO2 displaces alveolar O2 leading to arterial hypoxemia
142
How does respiratory acidosis affect P50
P50 is increased, causing a right shift in the curve.
| This releases more O2 at the tissues
143
How does respiratory acidosis affect cardiac and smooth muscle depression
Acidosis affects contractile protein and enzymatic function
Causes:
Myocardial depression
Vasodilation
144
How does respiratory acidosis affect SNS stimulation (5 factors)
CO2 activates the SNS and increases catecholamine release
- Tachycardia (inc O2 consumption and dec delivery)
- Vasoconstriction (inc O2 consumption)
- Dysrhythmias
- Prolong QT
- Offsets myocardial depression
145
How does respiratory acidosis affect alveolar ventilation
It increases
| CO2 is a respiratory stimulant and increases minute ventilation
146
How does respiratory acidosis affect K+ concentration
Increases by activating the H+/K+ pump***
| -Buffers CO2 in exchange for releasing K+ into plasma
147
How does respiratory acidosis affect Ca++ concentration
Increases b/c Ca++ and H+ compete for binding on plasma proteins
-H+ will bind with albumin and displace Ca++
148
At what point does CO2 narcosis occur
When PaCO2 > 90 mmHg
149
What are 8 causes of respiratory alkalosis
1. Iatrogenic (mechanical ventilation)
2. Hypoxia (altitude, profound anemia)
3. Pain
4. Anxiety
5. Pregnancy
6. Drugs (progesterone, salyicilate)
7. PE
8. Reduced DS with same alveolar ventilation
150
What are 4 CV effects of respiratory alkalosis
1. Dysrhythmias
2. Decreased coronary BF
3. decreased myocardial contractility
4. Decreased P50 (left shift, less O2 release)
151
What are 4 CNS effects of respiratory alkalosis
1. Inhibition of respiratory drive
2. Cerebral vasoconstriction
3. Neuronal irritability
4. Confusion
152
What are 2 electrolyte effects of respiratory alkalosis
1. Decreased potassium
| 2. Decreased calcium
153
What are 3 etiologies of metabolic acidosis
1. Accumulation of nonvolatile acids
2. Loss of HCO3
3. Large volume resuscitation w/ NaCl
154
What is the difference between anion gap acidosis and non-gap acidosis
Gap acidosis = accumulation of acids
Non-gap acidosis = loss of HCO3 or ECF dilution
155
How does the body compensate for metabolic acidosis
By eliminating volatile acids (CO2) with increased minute ventilation
156
How is PaCO2 affected by HCO3 levels
PaCO2 decreases by 1-1.5 mmHg for every HCO3- decrease of 1 mEq/L
PaCO2 increases by 0.5-1 mmHg for every HCO3 increased of 1 mEq/L
157
In what setting of metabolic acidosis is NaHCO3 indicated
Non-gap acidosis
| Because most causes are r/t HCO3 loss
158
What causes metabolic alkalosis
1. Increased HCO3
2. Loss of nonvolatile acids
3. Increased mineralocorticoid activity
159
What are causes of metabolic alkalosis related to increased HCO3
1. HCO3 administration
| 2. Massive transfusion
160
How does massive transfusion contribute to metabolic alkalosis
The liver converts the preservative from the transfusion into HCO3-
161
What are 4 causes of metabolic alkalosis related to loss of nonvolatile acid
1. Loss of gastric fluid
2. Loss of acid in urine
3. Diuretics
4. ECF depletion
162
What are 2 causes of metabolic alkalosis r/t increased mineralocorticoid activity
1. Cushing's syndrome
| 2. Hyperaldosteronism
163
How does the body compensate for metabolic alkalosis
The body will retain volatile acid (CO2) by reducing minute ventilation
164
How can metabolic alkalosis d/t increased mineralocorticoid activity be treated
Spironolactone
165
What type of acidosis is caused by loss of bicarbonate
Non-gap acidosis
166
Why can acetazolamide be used to treat metabolic alkalosis
It gets rid of HCO3
167
What are the 4 steps of fluid management
1. Fluid maintenance
2. Replacing fluid deficit
3. Replacing third space losses
4. Replacing blood loss
168
How is fluid maintenance calculated
4:2:1 rule
4 mL/kg/hr for first 10-kg
2 mL/kg/hr for second 10-kg
1 mL/kg/hr for each extra kg
OR Body weight in kg + 40 mL
169
How is fluid deficit determined
fasting hours x calculated hourly maintenance = estimate fluid deficit
170
How is surgical fluid loss calculated
Very minimal = 1-2 mL/kg/hr
-i.e. orofacial surgery
Minimal = 2-4 mL/kg/hr
-i.e. inguinal hernia repair
Moderate = 4-6 mL/kg/hr
-i.e. major non-abd surgery
Major = 6-8 mL/kg/hr
-i.e. major abd surgery
171
How is fluid replacement calculated for blood loss
```
Crystalloid = 3:1
Colloid = 1:1
```
172
What are 7 consequences of too little volume resuscitation during surgery
1. Decreased circulatory volume
2. Decreased O2 delivery
3. Decreased organ perfusion
4. Hemoconcentration (increased viscosity)
5. Myocardial ischemia
6. Renal impairment
7. PONV
173
What are 10 consequences of too much volume resuscitation during surgery
1. Excessive circulatory volume
2. Decreased O2 delivery from congestion
3. Impaired glycocalyx
4. Hemodilution
5. Increased extravascular lung water (impaired gas exchange)
6. Impaired wound healing
7. Increased risk of VAP
8. Abd compartment syndrome
9. Liver congestion
10. Impaired gut function (delayed emptying)
174
What is the goal of goal-directed fluid therapy
To optimize the pts position on the Starling curve
175
What does the slope of the Starling curve indicate in fluid resuscitation
Slope = pre-load dependent
| The pt is volume responsive and is a candidate for additional volume
176
What does the plateau of the Starling curve indicate in fluid resuscitation
Plateau = optimal balance between volume and myocardial performance
-Preload independence
177
What does the post-plateau down-slope of the starling curve indicate in fluid resuscitation
Overshoot = impaired cardiac performance
| The pt is at risk for pulmonary edema
178
What are 5 primary objective to enhance postsurgical outcomes in an ERAS program
1. Attenuate physiologic changes that accompany surgical trauma
2. Minimize impact of fluid shifts
3. Maximize nutritional impact of healing
4. Improve postop pain for faster recovery
5. Improve pt education and compliance
179
What are 5 intraop anesthetic actions used in the ERAS protocol that improve surgical outcomes
1. Short-acting drugs
2. Goal-directed fluid therapy
3. Maintain normothermia
4. PONV prophylaxis
5. Thoracic epidural when appropriate
