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28 Cards in this Set
- Front
- Back
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What separates the ICF from ECF
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cellular membrane
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What two compartments make up the ECF
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Intravascular (IVF) and interstitial (ISF)
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Major electrolytes found in ICF
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K, Mg, and Phosphate
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Major difference in the composition of IVF and ISF
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Albumin
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What are the Starting Forces?
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-capillary pressure
-ISF pressure - ISF colloid pressure -plasma colloid osmotic pressure |
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When should you administer an isotonic solution?
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Given when you expect water and electrolyte loss
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When would you administer a hypotonic solution
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Given when you only anticipate water loss.
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Complications of blood therapy
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1. allergic reaction
2. decrease in 2,3-DPG 3. citrate toxicity 4. TRALI 5. transmission of infectious diseases 6. metabolic abnormalities 7. transfusion associated graft vs host disease |
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Autologous Blood Transfusion can be achieved by?
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1. Normovolemic hemodilution
2. Predeposited Autologous blood 3. Intra and post-op blood salvage |
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If you give 1 unit of PRBC, how much increase will you expect in pt's H/H
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1g/dL in the hemoglobin/2-3% in hematocrit
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OR nurse just counted a soaked 'lap' towel. How much blood did your pt loose?
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100-150cc
*** one soaked 4x4 sponge holds 10cc |
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Is tachycardia a sensitve indicator of hypovolemia?
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No, because of the effects of anesthesia... CVP and BP are better indicators. Look at UO and sats too
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Which is better for resuscitation, colloids or crystalloids?
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They both are, but at different amounts. Colloid to crystalloid replacement ratio is about 1:3-4
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When would you choose Dextran 70 over Dextran 40
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Dextran 70 is best for volume expansion, and Dextran 40 to increase blood flow through microvasculature
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Disadvantages of colloid administration
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1. Expensive
2. Causes coagulopathies 3. Dextran can cause RF 4. Can cause osmotic diuresis 5. Albumin Can cause immune response |
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Disadvantages of crystalloids
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1. Dilutes plasma proteins
2. Has transient effect 3. Potential for pulmonary edema 4. Causes peripheral edema 5. reduces capillary osmootic pressure |
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How do we estimate maintenance fluid requirements
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- For the first 10kg give 4c/kg/hr
- For the next 10-20kg add 2cc/kg/hr -For each kg above 20kg, add 1cc/kg/hr |
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Maximum allowable blood loss formula is?
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EBV x (Starting hct - target hct) /starting hct
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Threshold for blood transfusion is?
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hemogobin of 7-8g/dL or hematocrit of 21-24%.
This is a general rule, that excludes pts with cardiac and pulmonary diseas, and older adults. Also all pt's are different |
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What happens when you give large amounts of Ns
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hyperchloremic-induced non-gap acidosis
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Indirect effect of NMBs on fluid requirements
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NMBs have no CV effects, but they can cause the release of histamine and decrease SVR = venous pooling. You will need to give more
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You are doing a preop physical assessment, what should you assess for to determine fluid status
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1. mucous membranes
2. skin turgor 3. strength of peripheral 4. BP and ortho BP 5. resting HR 6. UO |
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What lab test would you want to get on a pt. to assess fluid status?
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1. serial hematocrit
2. ABG and base deficit 3. urine specific gravity 4. serum Na 5. creatnine to BUN ratio |
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Administration of large volumes of LR will result in?
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metabolic alkalosis
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Examples of Isotonic solutions are?
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NS, D5 1/4NS, LR, Plasmalyte
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Hypotonic solutions include?
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D5W, 0.5NS,
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Hypertonic solutions include?
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D5 1/2NS, D5 NS, D5 LR, 7.5%NaHCO3, 3% NS, 5% NS
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Rapid correction of serum Na can lead to?
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Myelinosis, also known as central pontine myelinolysis (CPM).
*** Common in pts with hx of ETOH abuse and OLT |
