IV Fluids Flashcards

Question

NS Electrolyes

Answer 1

Na+ 154mEq/L Cl¯ 154mEq/L pH 6 310mOsm/L

Answer 2

``` Isotonic solution Expensive $$$ Most closely replicates physiologic electrolytes Ideal fluid in neuro patients Okay to mix w/ blood products ```

Answer 3

``` Na+ 140mEq/L K+ 5mEq/L Cl¯ 98mEq/L Mg2+ 3mEq/L Ca2+ 0 Glucose 0 Acetate 27mEq/L Gluconate 23mEq/L pH 7.4 ```

Answer 4

``` Hypotonic solution (260mOsm/L) Dextrose rapidly metabolized → only H2O remains Causes free water intoxication & hyponatremia Hyperglycemia (except diabetic receiving insulin or neonate) ```

Answer 5

3% Na+/Cl¯ 513mEq 5% Na+/Cl¯ 856mEq Bullet 23.4% imminent herniation Treat hyponatremia Low volume resuscitation, burns, closed head trauma Risk hyperchloremia, hypernatremia, & cellular dehydration

Answer 6

1:1 replacement Half-life 16hrs 2-3hrs in pathophysiological stress Goal to pull fluid into intravascular space

Answer 7

``` Blood derived colloid solution Obtained from fractionated human plasma Available 5% or 25% Expands IV up to 5x administered volume Plasma 1/2 life 16hrs ```

Answer 8

Water-soluble glucose polymers Enzymatically degraded to glucose 70 - volume expansion 40 - improve microcirculation blood flow & prevent thrombosis HIGHLY antigenic → anaphylactic reaction Test dose 10mL Platelet inhibition, non-cardiac pulmonary edema, interference w/ cross-matching

Answer 9

``` Hespan (0.95% NaCl) Hextend (balanced electrolyte solution) NOT blood derivative Less effective than albumin to expand volume, but less expensive Primary renal excretion Coagulopathy d/t dilutional thrombocytopenia Max dose <20mL/kg/day Oncotic pressure 30 ```

Answer 10

MIVF 4-2-1 4mL/kg/hr 1st 10kg = 40mL/hr 2mL/kg/hr 2nd 10kg = 20mL/hr 1mL/kg/hr each additional kg Any patient >20kg Weight + 40 = mL/hr 120kg + 40 = 160mL/hr

Answer 11

NPO replacement Replace 1/2 deficit 1st hour + MIVF Replace 1/4 deficit 2nd hour + MIVF Remaining 1/4 deficit 3rd hour + MIVF

Answer 12

``` Calculated MIVF x hours NPO 120kg NPO 12hr 160mL/hr x 12hr = 1,920mL 960mL replace 1st hour 480mL replace 2nd & 3rd hours ```

Answer 13

Minimal 0-2mL/kg/hr Moderate 3-5mL/kg/hr Severe 6-9mL/kg/hr Emergency 10-12mL/kg/hr

Answer 14

Eye, lap chole, hernia, knee scope | 0-2mL/kg/hr

Answer 15

Open chole or appendectomy | 3-5mL/kg/hr

Answer 16

Bowel surgery Total hip replacement 6-9mL/kg/hr

Answer 17

Gunshot MVA 10-12mL/kg/hr

Answer 18

``` 1 gram = 1cc Soaked 4x4 gauze = 10cc Ray-tech = 10-20cc Soaked laparotomy pads = 100-150cc Wet sponges 20-30% dry value Floor spills 1" = 5cc 2" = 20cc 3" = 45cc 4" = 80cc 1:1 replacement ```

Answer 19

``` Infants 80mL/kg Children 75mL/kg Adult male 75mL/kg Adult female 65mL/kg Elderly M 65mL/kg Elderly F 60mL/kg ```

Answer 20

[EBV x (starting Hct - allowable Hct)] / starting Hct

Answer 21

ABO-Rh typing | 98% compatible

Answer 22

ABO-Rh type + screen Specific antibodies commonly associated w/ non-ABO hemolytic reactions 99.94% compatible

Answer 23

Confirms ABO-Rh typing (<5min) | Detects antibodies to other blood groups & in low titers (up to 45min)

Answer 24

Hgb <6g/dL | Hgb 6-10g/dL transfusion based on patient risk, complications, and inadequate oxygenation S/S

Answer 25

Replace patient total blood volume in <24hr Acute admin >1/2 patient EBV in 3hr or less Transfusion 10units RBCs in 24hr

Answer 26

Infection - Hep B/C, HIV, bacterial sepsis Allergic or febrile reactions TRALI or non-cardiogenic pulmonary edema Hemolytic reactions Acute hypotension transfusion reaction Metabolic complications ↓pH ↑K+ Coagulopathy (after massive transfusion >10units) Dilutional thrombocytopenia (responds well to platelet transfusion) ↓Factors V/VIII DIC - clotting system activation Citrate toxicity

Answer 27

Preservative that acts as anticoagulant in stored blood Binds to Ca2+ Calcium admin not warranted unless iCal low Hypocalcemia (clinically significant - resulting in cardiac depression) does not occur unless transfusion rate exceeds 1 unit every 5min

Answer 28

1 unit ↑Hgb 1g/dL & Hct 2-3% | 10mL/kg transfusion ↑Hgb 3g/dL & Hct 10%

Answer 29

``` Anemia Preop MI d/t anemia Administering wrong unit Require more frequent blood transfusion Febrile & allergic reaction ```

Answer 30

Salvage blood from surgical site Blood processed - washed & separated Red cells are transfused back to patient Contraindications include malignancy, infected wounds, sepsis, chemical contaminants

Answer 31

Remove blood from patient after induction & replace w/ crystalloid or colloids After surgical blood loss has slowed or stopped transfuse blood back to patient ↑Hct

Answer 32

1 unit obtain via centrifuging Used to treat thrombocytopenia, dysfunctional platelets, active bleeding, platelet count <50,000 Volume 200-400cc (multiple donors) 1 unit ↑platelet count 7,000-10,000 one hour after transfusion ↑incidence platelet related sepsis 1:12,000 Bacterial contamination risk 1:2,000

Answer 33

Contains clotting factors & plasma proteins (no platelets) Volume 200-250cc ABO compatible Used to treat Warfarin reversal, coagulation factor deficiencies, correct microvascular bleeding ↑PT/PTT Each unit ↑clotting factor level 2-3% FFP contraindicated to augment plasma volume or albumin concentration

Answer 34

Derived from precipitate remaining after FFP thawed Contains fibrinogen, factor VIII (hemophilia A), von Willebrand factor, XIII Used to treat von Willebrand's disease & fibrinogen deficiencies (i.e. massive transfusions) ABO compatible Admin via filter rapidly (200mL/hr) & complete infusion w/in 6hr