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Emergency Medicine > IV fluids and Blood Products > Flashcards

IV fluids and Blood Products Flashcards

1
Q

Fxn of blood? What can impair this?

A
  • deliver O2 to tissues
  • anemia can impair O2 delivery
  • Oxygen delivery is determined by the formula:
    DO2 = COxarterial O2 content
  • can tolerate Hgb down to 10 b/f O2 demand starts exceeding supply
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2
Q

Transfusion risks?

A
  • infection
  • allergic and immune transfusion rxn
  • volume overload: elderly, kids, CHF
  • Hyperkalemia: newborns, renal failure, massive transfusions
  • Iron overload: large number of transfusions: ex
    chronic anemia in those who have repeat transfusions
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3
Q

What is considered a a massive transfusion? Complications (PATCH)?

A
  • replacement of blood volume in 24 hr period of more than 50% of blood vol in 4 hrs
  • complications: PATCH
    Platelets decrease, K+ increases
    ARDS, acidosis
    Temp decrease
    Citrate intoxication
    Hemolytic rxn
  • don’t forget about coag factors if replacing blood w/ PRBCs - may need until of FFP
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4
Q

What is a type and screen?

A
  • determines ABO and Rh status and presence of most commonly encountered ABs
  • risk of adverse rxn - 1:1000
  • takes about 5 min
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5
Q

What is a type and crossmatch?

A
  • determines ABO and Rh status as well as adverse rxn to even low incidence Ags
  • risk of adverse rxn - 1:10,000
  • takes about 45 min
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6
Q

What are the transfusion thresholds?

A
  • no universal guidelines
  • decision to transfusion shouldn’t be based on Hgb/Hct levels alone
  • no role for transfusion at Hgb of more than 10 g/dL
  • depending on clinical situation and the society’s guidelines: range of transfusion is anywhere from Hgb 6-10 g/dL
  • studies indicate that target Hgb values of 7-8 g/dL are assoc w/ equivalent or better outcomes in many pt pop: compared w/ Hgb of 10 g/dL
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7
Q

Why not transfuse bf Hgb gets so low?

A
  • rate of normal O2 delivery exceeds consumption by factor of 4
  • theoretically if fluid vol and CV status is maintained O2 delivery will be adequate until Hct goes below 10
  • compensatory mech: increased CO, rightward shift of O2-hemoglobin dissociation curve, increased O2 extraction
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8
Q

What should be the components of your deciding to transfuse?

A
  • Hgb level
  • clinical status
  • co-morbidities
  • pt preference
  • can check Hgb/Hct 15 min post infusion to assess status (if not actively bleeding)
  • if stable - considere transfusing one unit of PRBCs at a time (instead of mult units in initial order)
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9
Q

What is in cryoprecip? When should it be given?

A
  • fibrinogen, vWF, VIII, fibronectin

- if pt needs fibrinogen like in DIC give Cryo

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10
Q

When should you use FFP?

A 
- need clotting factors:
reverse warfarin
transfusing PRBCs 
large transfusions 
liver disease: pre surgery
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11
Q

When do you transfuse platelets?

A
  • sx thrombocytopenia
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12
Q

Rarest blood type?

MC blood type?

A
  • rarest: AB -

- MC: O+, A+

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13
Q

What are crystalloids?

A
  • solns that contain small molecules and are able to pass through semipermeable membranes
  • isotonic: expand ECF
  • hypotonic: given to reverse dehydration
  • hypertonic: given to increase ECF and decrease cellular swelling
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14
Q

What are colloids?

A
  • solns that contain high MW proteins or starch
  • don’t cross capillary semipermeable membrane and remain in intravascular space: pull fluid out of intracellular and interstitial space for several days
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15
Q

ex of Colloids?

A
  • albumin
  • dextran
  • hexastarch
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16
Q

ex of crystalloids?

A
  • D5W, D10W, D50W
  • saline
  • combo: D5 1/2 NS, D5NS, D10NS
  • ringer’s lactate
17
Q

Intracellular vs extracellular?

A 
- intracellular:
inside body cells
2/3 total body water
- extracellular:
intravascular space
interstitial space 
1/3 of total body water
18
Q

S/S of intravascular depletion?

A
  • decreased BP, flat jugular veins
  • increased HR
  • cool extremities
19
Q

S/S of interstitial fluid depletion?

A
  • decreased skin turgor, sunken eyeballs, wt

- can also have hemodynamic effects

20
Q

If given 1 L of dextrose how is it handled?

A
  • ECF 1/3: 300 ml
    1/4 of ECF: 75 ml
  • ICF 2/3: 700 ml
  • handled like free water, will diffuse just like body water, don’t give to pt bleeding (intravasc deficit)
21
Q

If given 1 L of 0.9% NS how is it handled?

A
  • isotonic - distributed in ECF since cell membrane not permeable to Na
  • so ECF gets the full 1 L
    interstitial: 3/4 (750 ml)
    intravasc: 1/4 (250 ml)
22
Q

How is 1 L of 5% albumin and PRBCs handled?

A
  • remains in intravascular space

- intravascular space = 1 L `

23
Q

How is 1/2 NS handled?

A
  • 1/2 as free water (goes out into ICF)

- 1/2 as saline (stays in ECF)

24
Q

Which lytes are lost in sweat and exhaled water vapor?

Which ones are lost in urine?

A
  • none are lost in sweat and water vapor
  • all lytes are lost in urine:
    renal failure pts don’t need maintenance Na or K
25
Q

How is Na regulated?

A
  • serum Na = osmolality = water
  • Na is regulated by thirst, ADH, renal water handling
  • a disruption in water balance is manifested as an abnorm in serum Na
  • Na is fxnlly impermeable solute so it contributes to tonicity and induces water movement across membranes
26
Q

What will Na levels be in loss from a GI source?

A
  • high because lost everything else

- replacing w/ fluid fixes problem

27
Q

Fluid loss occurs via?

A
  • GI
  • Renal
  • vascular
  • skin
28
Q

Fluid gain occurs via?

A
  • iatogenic (fluid replacement)
  • heart failure
  • liver failure (albumin decreases - oncotic pressure decreases - fluid leaks out from vasculature)
  • kidney failure
29
Q

25 yo pt presents w/ massive hematemesis x 1 hr and has hx of PUD, diaphoretic w/ normal skin turgor. Orthostatic hypotension, Na of 140, What fluids should be given?

A
  • bleeding so want intravasc replacement -

can do NS

30
Q 
18 yo w/ severe D/V x 48  hrs 
- exam: sunken eyeballs, poor skin turgor, dry mucous membranes
- BP 80/60, HR 130 supine
labs:
Na 148, K 2.8, HCO3 22
WHat should be done?
A
  • extracellular depeletion = interstitial
  • has hypernatremia, and hypokalemia
  • needs crystalloid - LR or NS w/ K+
  • most likely has metabolic alkalosis from vomiting
31
Q

85 yo F nursing home resident w/ known dementia presents w/ worsening confusion -
exam: disoriented, decreased skin turgor, has slight Ortho hypotension, labs - Na 150, Hct 45, BUN/Cr 50/1.8, blood glucose 1200 -
what does pt have? Correction?

A
  • DKA: has high K as well (hyperkalemia in DKA)
  • tx w/ insulin drip (will drive K+ back into cell)
  • need massive fluid replacement w/ DKA - NS or 1/2 NS (b/c high Na)
  • check K+ levels hourly
32
Q

What are the rules of fluid replacement?

A
  • replace blood w/ blood
  • replace plasma w/ colloid
  • resuscitate w/ colloid or Ringers
  • rehydrate w/ dextrose if you want fluid distributed to all body compartments

Emergency Medicine (22 decks)

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