Required Reading-Fluids/Intraop Complications Flashcards Preview

Anesthesiology > Required Reading-Fluids/Intraop Complications > Flashcards

Flashcards in Required Reading-Fluids/Intraop Complications Deck (58):
1

Total body water is _____ of body weight. Intracellular is ___ and extracellular (interstitial fluid and plasma) is ____.

60%; 40%; 20%

2

Extracellular to intracellular shift of fluids cause dramatic illnesses, such as ____ of cells, swelling of ______ and ____.

lysis; brain/SC; renal failure

3

If 70kg man, TBW is ____, intracellular water is ____ and extracellular water is ____.

42L; 28L; 14L

4

Extracellular fluid consists of ____ (16% TBWt) and ____ (4% TBWt)

interstitial fluid (~11.2L); plasma (~2.8L)

5

RBCV + plasma volume is ___ liters, or the total blood volume

2L + ~3L = 5L

6

CO is about ____ per minute

5L

7

Transfusing blood products adds volume to BOTH ____ and ___ space.

extracellular; intracellular (RBCV)

8

Fluids are to support ___ of heart, avoid excessive expansion of ____ space, allow some ____ fluid to be transported back into intravascular space, and avoid changing ____ space (specifically in neurons)

preload; interstitial; interstitial; intracellular

9

Clinical var to assess intravascular volume status include:

skin turgor, neck veins, SBP, var of BP w/ respiration, CVP, HR, UO, hypoTN w/ anesthesia, orthostasis, base excess or HCO3

10

An increase in variability of BP w/ respiration indicates ___ intravascular volume status.

hypovolemic

11

A CVP between ____ indicates normal intravascular volume status.

8-12mmHg

12

Base excess less than -2 or HCO3 mEq/L less than 22 indicates ___ intravascular volume status.

hypovolemic

13

Pts kept deliberately hypovolemic are those with elevated ____ pressures, ____ pts, or after ____ surgeries.

pulmonary artery; COPD; thoracic

14

Crystalloids, like NS, LR (contains Ca+, K+, lactate), normosol-R mostly diffuse into ____ space and is for mostly minor procedures.

intracellular

15

Colloids are derived from human serum protein macromolecules like ____, or carb macromol like ___.

albumin/Plasmanate; Hetastarch

16

B/c oncotic pressure, macromol in colloids allows them to remain in ____ longer (hrs-days) than crystalloids (min-hrs)

intravascular space [minimize wt gain/edema]

17

Albumin 5% used for ____ replacement. If not diluted with NS (as opposed to 1/2NS), can cause fatal ____.

volume; hemolysis

18

Plasmanate contains 88% albumin and also alpha/beta/gamma ____; considered to be ______ therefore not given to Jehovah's Witnesses. Diluted w/ NS.

globulins; blood product

19

Hetastarch derived from ____ and not a blood product; also less expensive than protein-derivatives

vegetable matter [complex carbs]

20

Calculating periop fluids: (1) Maintenance fluids (2) NPO (3) EBL (4) "third-space" loss

(1) 4 + 2 + 1 rule = 100ml/hr for first 60kg + 1ml/hr*remaining kg
(2) 8h x (maint. fluids) [give in first 2hrs] (3) 3 x EBL (4) minor 1-3ml/kg/h, laparoscopy 3-6ml/kg/h, exlap 6-10ml/kg/h

21

Estimate periop fluids for 100kg man who hasn't eaten for 8 hrs, EBL about 100ml for 2h lap chole.

(1) Maintenance fluids = 140ml/h (2) NPO = 1220ml (3) EBL = 300ml (4) "third-space" loss = 500ml/h; Total = 2700 ml/h LR over 2h periop period

22

MC use for D5W

withdrawing alcoholic pts from becoming hypoglycemic

23

MC use D51/2NS + 30mEq KCL/l

classic maintenance fluid for medicine on ward (insensible losses)

24

MC use NS; MC problem

replacement for initial resuscitation for dehydration and blood loss; may cause metabolic acidosis

25

MC use LR; MC problems (3)

replacement periop losses; (1) calcium makes incompatible w/ blood products and (2) liver dz pts may not tolerate lactate (impaired gluconeogenesis) (3) hyperkalemia

26

MC use Normosol

cardiac/renal/hepatic transplant b/c no lactate load

27

MC fluids where losses exceed 2L

Hetastarch, Albumin/Plasmanate [also if edema and hypoalbuminemia]

28

MC prob Hetastarch

may induce coaggulopathy if >2L given; inhibits vWF

29

ABG measures these 4 values

pH, PaCO2, PaO2, HCO3- [base excess is derivative calculation]

30

In addition to ABG, also know ___ to know quality of O2 delivery and ___ to know if there are compensatory mechanisms working

inspired O2 (FiO2); anion gap = serum Na+ – [Cl- + HCO3-]....nml 12-20mEq/L

31

Respiratory acidosis MCCs: [remember dec excretion of CO2 and inc prod CO2]

hypoventilation (dec minute ventilation), obstruction sm airways, COPD, asthma, OD EtOH, sedatives, opioids, myasthenia gravis, hyperthermia, overfeeding [overprod CO2]

32

Metabolic acidosis MCCs w/ anion gap

lactic acidosis/ethanol in blood: MUDPILES--methanol, uremia, DKA, phenytoin/propylene glycol, INH, lactate, ethylene glycol, salicylates

33

Metabolic acidosis MCCs w/ NO anion gap:

hyperchloremic acidosis--diarrhea, NaCl solns (surgery or s/p blood loss), acetazolamide, renal tubular acidosis

34

Respiratory alkalosis MCCs:

hyperventilation, hypothermia, muscle relaxation from NONDEPOL NMBs, anxiety from CNS lesion, altitude, pregnancy

35

Metabolic alkalosis MCCs

vomiting, diuretics (furosemide), antacids, hyperaldosteronism

36

MC problems metabolic alkalosis; Tx

arrhythmias, cerebral vasoconstriction, coronary vasoconstriction, can also cause retention CO2 in blood; NS +/- KCl, dilue HCl, acetazolamide

37

Chronic respiratory ACIDOSIS or ALKALOSIS calculation base excess (anion gap)

BE = 0.4 x (PaCO2 - 40)

38

Allowable Blood Loss [ABL] formula

EBV x (HCTinitial – HCTfinal) / HCTinitial

39

One gram of Hb is equivalent to _____ HCT percentage points. Each unit of PRBC in an adult is expected to raise HCT by ___ points.

3; 3

40

Estimated Blood Volume (EBV) formula

wt (kg) x average blood volume [male abv = 75ml/kg; female = 65ml/kg]

41

If EBL is greater than one liter, must place ____ monitor

CVP (central venous pressure)

42

Pulmonary artery [PA] monitors are better at measuring ____ than CVPs.

volume status (can sample mixed venous blood and also can assess total O2 delivery)

43

____ is given for severe coaggulopathy and Factor VIII deficiency

Cryoprecipitate

44

Factor IX concentrate has factors ___, ___ and nontherapeutic levels of ____

II; X; VII

45

MC transfusion rxn is Major Acute Hemolytic Reaction, which is from ___ or ___ incompatibility and due to human clerical error.

ABO; Rh

46

In Acute Hemolytic Rxn, free Hb can damage the ____. Tx is to stop transfusion and use ___ or ____ for diuresis, as well as supportive care.

kidneys; mannitol; furosemide

47

MC transfusion infection is ____. Least common is ____.

CMV; Malaria

48

Delayed hemolytic transfusion rxn occurs after admin of multiple RBC transfusions, usually for ____. IgM and complement involved.

SCD

49

Anaphylactic rxn in transfusion occurs most in pts with cases of _____

selective IgA deficiency

50

Sxs of TRALI include ______. Supportive care and mech ventilation is needed.

respiratory distress, fever, non-cardio pulmonary edema, hypoTN

51

TRALI due to antibodies in donor against ____ antigens in recipient [ie crossmatch compatible]. Causes pulmonary capillary leak.

HLA

52

Use FFP for ____ bleeding, ___ drug therapy needing reversal, massive transfusion, ____ , C1 esterase inhibitor deficiencies

ACTIVE; warfarin; TTP

53

Minor febrile non-hemolytic transfusion rxn may occur even if ____ is compatible.

crossmatch

54

Minor febrile non-hemolytic transfusion tx is diphenhydramine, acetaminophen/ibuprofen and monitoring ____ and ___

vital signs; UOP

55

Transfusion-- ____ can be prevented with inline IV fluid warmer

hypothermia

56

Transfusion--_____ can occur b/c PRBCs tend to lyse and release products the older they are; closer to expiration can cause increase in ion concentrations

hyperkalemia

57

Transfusion--____ common b/c citrate anticoagulant binds; transiently can cause vaso___ and hypoTN.

hypocalcemia; dilation

58

Treat hypocalcemia due to transfusion with either 1-2g of ____ or ____

calcium chloride; calcium gluconate [NOT calcium bicarb or it will precipitate]