Fluid And Blood, Basics Of Anesthesia

Front 1

What is human body water %
At Birth?
At 1 month?
avg male?
avg female?

Back 1

Birth - 75%
1 month - 65%
Adult male - 60%
adult female - 50%
older adult lower %

Front 2

Compartments that hold H2O
Intracellular
Extracellular
intravascular
interstitial

Back 2

ICF = 40%
ECF = 20%
Intravascular = 5%
Interstitial = 15%

Front 3

What is the movement of water across a semi-permeable membrane?

Back 3

osmosis
driven by solute concentration gradient

Front 4

What is pressure exerted by the side with more solute particles to prevent the net movement of water across the membrane

Back 4

osmotic pressure (colloids)

Front 5

What is the molecular weight of a non-dissociable substance?

Back 5

osmole

Front 6

number of osmoles per liter

Back 6

osmolarity

Front 7

number of osmoles per kg

Back 7

osmolality

Front 8

number of osmoles in a solution and it's effects on the cell volume

Back 8

tonicity

Front 9

what is the volume and concentration of intracellular fluid regulated by?

Back 9

outer cell membrane.
K is the determinant of intracellular osmotic pressure

Front 10

Provides a medium for cell nutrients, electrolytes and cellular waste products
Also, is composed of intersitial and intravascular compartments?

Back 10

Extracellular fluid

Front 11

What regulates oncotic pressure?

Back 11

plasma proteins

Front 12

What does the intravascular fluid (plasma) consist of?

Back 12

albumen, water, ions, nutrients, gases, waste products, hormones, enzymes, lactic acid.

Front 13

What are the characteristics of interstitial fluid?

Back 13

1. low protein concentration
2. small amounts of free fluid
3. negative pressure compartment (-5mmHg)

Front 14

Movement of molecules b/w compartments guided by kinetic energy they exert.

Back 14

diffusion

can be facilitated, active, etc

Front 15

fluid exchange across cell membrane =

Back 15

osmosis

Front 16

Fluid exchange across capillary endothelium =

Back 16

osmosis
hydrostatic pressure

Front 17

Most important mechanism of fluid volume regulation

Back 17

thirst

Front 18

What is thirst triggered by?

Back 18

increased tonicity
or decrease in ECF volume

Front 19

When is ADH released?

Back 19

1.From the posterior pituitary in response to changes in blood osmolarity
2. response to stimulation of
baroreceptors as response to 5-10% decreased blood volume
3. hypotension, pain, nausea, stress, hypoxia

Front 20

This is released from cardiac atria in response to increased atrial stretch.
and, what does it do?

Back 20

ANP
causes vasodilation
increases renal excretion of NA and H2O

Front 21

This prevents Na depletion and hypovolemia.
secreted by adrenal cortex, triggered by dec Na lvl, or inc Na in urine

Back 21

Aldosterone

Front 22

What is the ultimate goal of fluid volume replacement?

Back 22

Tissue perfusion and oxygenation

Front 23

Ideal osmolarity of body fluids?

Back 23

300 mOsm/L

Front 24

Hypotonic

Back 24

D5W (253 mOsm/L)
1/2 NS (154 mOsm/L)

Front 25

Isotonic Solutions

Back 25

NS (308 mOsm/L)
D5 1/4NS (355 mOsm/L)
LR (273 mOsm/L)
lactate --> bicarb in liver
Isolyte (294 mOsm/L)

Front 26

Hypertonic Solutions

Back 26

D5 1/2NS (432 mOsm/L)
D5NS (586 mOsm/L)
D5LR (525 mOsm/L)
3%NS (1026 mOsm/L)
5%NS (1710 mOsm/L)
7.5%NS (1786 mOsm/L)

Front 27

What is Dextran 70 for?

Back 27

volume expansion

Front 28

What is Dextran 40 for?

Back 28

used to improve or maintain blood flow at the microcirculation level

Front 29

Which colloid affects platelet aggregation at larger doses?

Back 29

Hespan (doses 20ml/kg/day)

Front 30

name 3 indications for colloids

Back 30

1. fluid resuscitation for severe IV deficit
2. rapid IV volume expansion
3. fluid relacement in setting of large protein loss (burn, hypoalbumenemia)

Front 31

what type of solution is used to replace insensible loses and 3rd space loses?

Back 31

isotonic

Front 32

What are the principle electrolytes affecting the choice of crystalloid solution?

Back 32

Na, K, Cl

Front 33

What can occur with large amounts of saline solutions?

Back 33

hyperchloremic metabolic acidosis

Front 34

What can occur with large amounts of LR?

Back 34

metabolic alkalosis from bicarb production

Front 35

Who gets dextrose solutions?

Back 35

people at risk for hypoglycemia
diabetics, children, infants

Front 36

What is the blood volume of neonate?
premi
full term
infant
adult male
adult female

Back 36

premie 95ml/kg
full term 85ml/kg
infant 80ml/kg
male 75ml/kg
female 65ml/kg

Front 37

which chromosome expresses blood type?

Back 37

9

Front 38

which patients develop antibodies to Rh when exposed?

Back 38

RH negative develop antibodies after exposure to RH positive blood

Front 39

which blood can be given 911?

Back 39

o Neg

Front 40

What is the HCT of PRBC's?

Back 40

70-80%

Front 41

each unit of blood with increase H/H?

Back 41

1/3

Front 42

why do we transfuse PRBC's?

Back 42

to increase oxygen-carrying capacity

Front 43

Is ABO compatibility required for FFP?

Back 43

yes

Front 44

What are indications for FFP?

Back 44

1. urgent reversal of warfarin therapy
2. correction of PT/PTT
3. Correction of coag from ESLD
4. correction of microbleeding during massive transfusion

Front 45

How many donors are involved one unit of platelets?

Back 45

6

Front 46

each unit increases PLT count?

Back 46

5-10,000 u/L

Front 47

How long do transfused plt last?

Back 47

1-7 days

Front 48

Is ABO/RH compatibility required for plt transfusion?

Back 48

it is desired

Front 49

At what plt count do people spontaneously bleed?

Back 49

10-20,000 u/L
thrombocytopenia = <150,000

Front 50

What are indications for plt transfusion?

Back 50

1. plt count <50,000
2. maintainance of plt lvl during ongoing bleeding
3. thrombocytopenia
4. dysfx plt

Front 51

What does cryoprecipitate contain?

Back 51

fraction of plasm that precipitates when thawed
Factors 8,9, von Willebrand fx, and fibrinogen
ABO not required

Front 52

What are indications for cryo?

Back 52

1. Microvascular bleeding due to massive blood xfusion
2. prophylaxis before surgery in patients with dyfibrinogenemias
3. prophylaxis before surgery in pts with hemophilia A or vWD if concentrates not available.

Front 53

How many weeks prior to surgery must autologus blood be donated?

Back 53

4-5 weeks

Front 54

What H/H must be maintained with autologus blood donation?

Back 54

11/32

Front 55

What is the HCT of cell saver after it is washed?

Back 55

50% the initial HCT

Front 56

What are C/I of cell saver?

Back 56

1. malignant cells
2. contaminated surgical field
3. urine, bowel, amniotic fluid

Front 57

What are complications of cell saver?

Back 57

1. fat/air embolism
2. hemolysis
3. dilutional coagulopathy with large volumes

Front 58

When is RBC transfusion rarely indicated?
How bout, almost always indicated?

Back 58

hemoglobin >10 g/dL
hemoglobin <6 g/dL

Front 59

What are the s/s of acute hemolytic reaction?

Back 59

tachycardia, hyperthermia, hypotension, hemoglobinuria, oozing in surgical field

Front 60

What is tx for acute hemolytic reaction?

Back 60

1. stop transfusion
2. support CV
3. osmotic diuresis (fluids, mannitol, lasix)
4. Renal dose dopamine (WHAT?)
5. Recheck unit of blood/slip
6. Return to blood bank

Front 61

What is it called when a patient has an increased temp (>1 celcius) within 4 hrs of transfusion?

Back 61

febrile reaction
from reaction to donor's wbc's, plts

Front 62

What is TRALI?

Back 62

1. rare complication
2. transfusion of antileukocytic antibodies
3. WBC's aggregated in pulm circulation
4. damage to aleolar/capillary membrane
5. pulmonary edema
6. resovles in 12-48 hrs