Fluids and Blood Flashcards
What two compartment make up the ECV?
ECV = 34% of TBW, 2-% body mass
- Plasma volume
- Interstitial volume
How do you estimate fluid deficit?
4-2-1 rule
1-10kg = 4ml/kg/hr
11-20 = 40 + 2ml/kg/hr
Each kg >20kg = 60 + 1ml/kg/hr
Fever - for each degree >37, add 2.5ml/kg for every 24 hours
List 4 signs of hypovolemia
- dry mucous membranes
- dec sensorium
- dec UOP
- dec or variable BP with position and PPV
What 3 things most commonly cause fluid loss during surgery?
- Evaporation
- Internal redistribution
- Blood loss
What is the ratio of blood loss to crystalloid replacement?
1L blood : 1.3-1.6L crystalloid
What are the contents in Normal Saline?
pH 5.0
Osmolality 308
Na 154
Cl 154
What are the contents in LR?
pH 6.5 Osmolality 275 Na 130 Cl 109 K 4 Ca 3 Lactate 28
What are the contents in Plasmalyte?
pH 7.4 Osmolality 294 Na 140 Cl 98 K 5 Mg 3
What are some side effects from using Hetastarch?
anticoagulant effects >20 mL/kg/day or 1L
decreased function of:
factor VIII
von Willebrand factor
fibrinogen
PRURITIS
Increased M&M in critically ill patients
What evidence is there about relative benefits and risks of crystalloid vs. colloid resuscitation?
SAFE study
No significant differences were found with respect to mortality
Albumin & hetastarch were found to be associated with higher mortality in patients with traumatic brain injury
What are some side effects from using Dextran?
decreasing platelet aggregation
prolonged bleed time
allergic reactions
Crystalloid solution associated with hyperchloremic metabolic acidosis in volumes >3L
NS
How much should transfusion of one unit of PRBCs increase [Hbg], in the absence of continued bleeding?
1g/dL
Describe the components of a unit of PRBCs
180 ml of RBCs
30 ml of citrate-phosphate-dextrose (CPD) anticoagulant preservative.
30 ml of plasma
Describe the symptoms of acute hemolytic reaction
awake patient - pain at the infusion site, dyspnea, chest pain, flank pain and rigors
anesthetized patient - red urine, hypotension, fever, and coagulopathy
- STOP transfusion
What is the starting dose for transfusion of FFP? What is the goal of FFP transfusion?
10-15 mL/kg, with the goal of achieving 30% of clotting factor concentration
What are the components of FFP?
250ml of volume
ALL plasma proteins and clotting factors
= not a concentrate of any of the clotting factors = should NOT be used to treat specific deficiencies (hemophilia) unless factor concentrates are not available
How is FFP stored and how long is its shelf life?
FFP is frozen at -18 to -30°C within 8 hours of collection
Gently thawed in water bath –> used within 6 hours
Used up to 1 year after collection
What are some indications for use of FFP?
- Rapid and emergent reversal of warfarin (one could also use Factor VIIa or various available concentrates of Factors II, VII, IX, and X).
- Correction of factor deficiencies in the absence of available factor concentrates.
- Correction of AT-III deficiency for patients receiving heparin (often in the setting of cardiac or vascular surgery, but a specific concentrate is also available).
- Correction of non-surgical (microvascular) bleeding in patients who have been transfused more than one blood volume.
- Correction of microvascular bleeding in patients with abnormal coagulation parameters. This applies to a PT more than 1.5 times normal, an aPTT more than 2 times normal, and an INR more than 2.0.
What are the implications of platelet storage temperature?
must be stored at room temperature = higher risk of transmitting infection and a shorter shelf life
What is the most common reason anesthesiologists transfuse cryoprecipitate?
microvascular bleeding + fibrinogen level
What is currently the best reason to administer dextrans?
plastic or vascular surgery to improve perfusion and decrease the risk of thrombosis
Where does cryoprecipitate come from and what are its contents?
FFP is thawed at 4°C, a precipitate remains, which can be separated by centrifugation = cryoprecipitate
Factor VIII Factor XIII von Willebrand factor Fibrinogen Fibronectin
Is ABO compatibility necessary for:
- Platelets?
- FFP?
- No - but incompatible –> shorter half-life
2. Yes