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WEEK 11 LECTURE Flashcards

1
Q

What is the whole purpose of fluid and blood management?

A

Oxygen delivery

This involves maintaining intravascular volume and managing fluid exchange.

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2
Q

What are the factors increasing surgical risks related to fluid management?

A
  • Emergency Surgery
  • Surgeries with Expected High Blood Loss
  • Long Surgeries with Large Fluid Shifts
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3
Q

List examples of high-risk surgical procedures.

A
  • Open Aortic Surgery
  • Peripheral Vascular Surgery
  • Neurosurgery
  • Thyroid Surgery
  • Prostatectomy
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4
Q

What percentage of total body water is intracellular volume (ICV)?

A

40%

Total body water is broken down into intracellular and extracellular volume.

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5
Q

What percentage of total body water is extracellular volume (ECV)?

A

20%

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6
Q

What are the components of extracellular volume?

A
  • Intravascular (Plasma) Volume
  • Interstitial (Tissue) Volume
  • Transcellular Fluids
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7
Q

What are the four components of Starling forces?

A
  • Capillary Hydrostatic Pressure
  • Interstitial Fluid Pressure
  • Plasma Oncotic Pressure
  • Interstitial Oncotic Pressure
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8
Q

What does capillary hydrostatic pressure (Pc) do?

A

Keeps blood pressure within the capillaries.

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9
Q

What is the effect of increased interstitial fluid pressure (Pif)?

A

It pushes fluid back into the capillaries (favoring absorption).

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10
Q

What is plasma oncotic pressure (πp)?

A

The osmotic pull exerted by proteins in the blood.

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11
Q

What happens to fluid movement in cases of hypoalbuminemia?

A

Fluid leaks into tissues leading to edema.

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12
Q

What does the Starling equation (Jv) represent?

A

Net fluid movement (positive means filtration, negative means absorption).

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13
Q

What is the daily fluid requirement range for adults?

A

25 to 35 mL/kg/day

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14
Q

What is the urine output threshold for oliguria?

A

< 0.5 mL/kg/hr

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15
Q

What factors can shift the Frank-Starling curve upward/leftward?

A
  • Positive inotropes
  • Sympathetic stimulation
  • Decreased afterload
  • Mild exercise
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16
Q

What are the types of intravenous fluids classified as crystalloids?

A
  • Normal Saline
  • Lactated Ringers
  • PlasmaLyte
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17
Q

What is the 4-2-1 rule for calculating fluid requirements?

A

First 10 kg: 4 ml/kg/hr; Next 10 kg: 2 ml/kg/hr; Remaining Weight: 1 ml/kg/hr

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18
Q

What are the advantages of crystalloids?

A
  • Cheaper
  • No allergenic potential
  • Easily metabolized
  • Renally cleared
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19
Q

What is a disadvantage of crystalloids?

A

Large volumes (3-4x more than colloids) are required to restore intravascular volume.

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20
Q

What are colloids?

A

Fluids containing higher-molecular-weight substances that exert osmotic pressure.

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21
Q

What is an example of a blood-derived colloid?

A
  • Albumin (5% & 25%)
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22
Q

What can excessive saline use lead to?

A

Hyperchloremic metabolic acidosis and increased risk of acute kidney injury.

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23
Q

What is the evaporative loss in surgical procedures associated with?

A

Obligatory losses of fluids other than blood due to evaporation.

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24
Q

What is the NPO fluid deficit formula?

A

NPO FLUID DEFICIT = HOURS NPO x HOUR FLUID REQUIREMENT

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25
What are evaporative losses in surgical procedures?
Losses of fluids other than blood due to evaporation and internal redistribution of body fluids.
26
How are evaporative losses significant in surgery?
They are most significant with large wounds, especially burns, and are proportional to the surface area exposed and the duration of the surgical procedure.
27
What is the hourly maintenance fluid requirement for superficial trauma?
1 to 2 mL/kg/hr
28
What is the hourly maintenance fluid requirement for minimal trauma?
2 to 4 mL/kg/hr
29
What is the hourly maintenance fluid requirement for moderate trauma?
4 to 6 mL/kg/hr
30
What is the hourly maintenance fluid requirement for severe trauma?
6 to 8 mL/kg/hr
31
What is the NPO deficit for a 120 kg patient undergoing laparoscopic cholecystectomy for 6 hours?
maintenance = 160 x 6hr NPO = 960ml
32
What are the consequences of inappropriate fluid administration?
* Hypovolemia * Decreased circulating volume * Decreased microvascular perfusion * Reduced tissue perfusion * End-organ complications * PONV * Renal dysfunction * Myocardial ischemia * Hemoconcentration
33
What is the definition of Goal Directed Fluid Therapy (GDFT)?
A fluid management approach that tailors fluid administration based on real-time hemodynamic variables.
34
What are the goals of Goal Directed Fluid Therapy (GDFT)?
* Optimize tissue oxygenation * Optimize perfusion * Prevent both over- and under-resuscitation
35
What is plethysmography variability index (PVI) used for in GDFT?
To assess dynamic fluid responsiveness.
36
What monitoring techniques are used in GDFT?
* Pulse contour analysis * Esophageal Doppler * TEE/TTE * Dilution techniques * Noninvasive monitors
37
What does the Allowable Blood Loss (ABL) equation help to calculate?
It helps to determine the maximum volume of blood that can be lost without requiring a transfusion.
38
What is Estimated Blood Loss (EBL)?
A quicker but less accurate method of estimating blood loss compared to Quantitative Blood Loss (QBL).
39
What are common techniques for estimating blood loss?
* Suction canisters * Visual estimation (e.g., soaked sponges)
40
What is the storage temperature and shelf life of Whole Blood?
Stored at 1–6°C for up to 35 days.
41
What is the volume of Packed Red Blood Cells (PRBCs)?
250–350 mL
42
What are the indications for administering PRBCs?
* Improve oxygen-carrying capacity * Anemia * Surgical blood loss * Hemorrhage
43
What is the shelf life of PRBCs?
21–42 days
44
What is a key role of platelets in the body?
Primary hemostasis
45
What are the indications for transfusing platelets?
* Active bleeding * Prophylactic use in at-risk patients
46
What is the volume and storage condition of Fresh Frozen Plasma (FFP)?
Volume: ~200–600 mL; Stored at –18°C for 1 year.
47
What is the composition of cryoprecipitate?
* Fibrinogen * Factor VIII * Factor XIII * vWF * Fibronectin
48
What does Prothrombin Complex Concentrate (PCC) provide?
Vitamin K-dependent factor replacement. *factors II, VII, IX, & X*
49
What is the storage condition for platelets?
Stored at 20–24°C with agitation.
50
What is the recommended hemoglobin level for transfusion?
Rarely indicated when hemoglobin is >10 g/dL and almost always indicated when <6 g/dL.
51
What is the pediatric dose of PRBCs?
10–15 mL/kg
52
What is the risk associated with bacterial contamination in platelets?
Risk due to room temperature storage.
53
What is Prothrombin Complex Concentrate (PCC)?
Vitamin K-dependent factor replacement used for urgent warfarin reversal ## Footnote PCC is critical in managing patients on anticoagulants who require quick reversal due to bleeding.
54
What is Recombinant Factor VIIa used for?
Last-resort option for life-threatening bleeding; dose: 15–20 µg/kg ## Footnote It is particularly useful in patients with hemophilia or those who have developed inhibitors.
55
What is Fibrinogen Concentrate used for?
Rapid correction of hypofibrinogenemia ## Footnote Hypofibrinogenemia can lead to increased bleeding risk, especially during surgical procedures.
56
What does TEG/ROTEM stand for?
Thromboelastography / Rotational Thromboelastometry ## Footnote These are tests used to assess the coagulation status and guide transfusion therapy.
57
What is the main purpose of blood donor screening?
Evaluate medical history and screen for infectious diseases ## Footnote Ensures the safety of blood transfusions for both donors and recipients.
58
What infectious diseases are screened in blood donations?
* Hepatitis B * Hepatitis C * Syphilis * HIV (anti-HIV-1 and anti-HIV-2 antibodies) ## Footnote Screening for these infections is crucial to prevent transmission through blood transfusions.
59
What is the purpose of leukocyte reduction in blood units?
Removes white cells to reduce febrile reactions, immunosuppression, and CMV transmission ## Footnote This process is especially important for patients who are immunocompromised.
60
What is the function of a Cell Saver Machine?
Collects, filters, and washes shed surgical blood for reinfusion (PRBCs only) ## Footnote This process helps minimize the need for donor blood during surgeries.
61
What is the role of a blood warmer during transfusions?
Warms blood to 37°C to prevent hypothermia ## Footnote Hypothermia can lead to complications during high-volume transfusions.
62
What does ANH stand for, and what is its purpose?
Acute Normovolemic Hemodilution; it is used to minimize blood loss during surgery ## Footnote Involves removing blood and replacing it with crystalloids or colloids before surgery.
63
What are antifibrinolytics and provide an example?
Medications that prevent the breakdown of fibrin; examples include tranexamic acid and epsilon aminocaproic acid ## Footnote These are used in high-risk surgeries to reduce bleeding.
64
What is the definition of hyponatremia?
Na⁺ < 135 mEq/L ## Footnote It can lead to neurological symptoms due to cerebral edema.
65
What is the treatment for hypovolemic hyponatremia?
Isotonic saline ## Footnote This helps to restore sodium levels without causing rapid shifts.
66
What are the clinical manifestations of hypernatremia?
* Restlessness * Lethargy * Seizures * Coma ## Footnote Neurological symptoms are due to cellular dehydration.
67
What is the treatment approach for hyperkalemia?
* Stabilize myocardium with IV calcium * Shift K⁺ into cells using insulin with glucose or bicarbonate * Remove K⁺ via diuretics or dialysis ## Footnote Timely treatment is crucial to prevent life-threatening cardiac arrhythmias.
68
What is hypocalcemia defined as?
Ionized Ca²⁺ < 4.0 mg/dL or Total Ca²⁺ < 8.5 mg/dL ## Footnote Symptoms may include tetany and seizures due to neuromuscular excitability.
69
What is the recommended treatment for acute hypocalcemia?
IV calcium (chloride or gluconate) ## Footnote Intravenous administration is preferred for symptomatic cases.
70
What are the causes of hypercalcemia?
* Hyperparathyroidism * Malignancy * Granulomatous disease * Immobilization * Milk-alkali syndrome ## Footnote Identifying the underlying cause is essential for effective treatment.
71
What is the initial treatment for significant hypercalcemia?
IV saline hydration followed by loop diuretics ## Footnote This helps to promote calciuresis and reduce calcium levels.

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