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11 Cards in this Set
- Front
- Back
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Calculation of the dose of sodium bicarbonate
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Sodium bicarbonate dose = Body weight (kg) x Deviation of plasma bicarbonate from 24 mEq/L x Extracellular fluid voLume as a fraction of body mass (O.3)
Administer half the calculated dose and repeat the measurement of pHa to determine the impact of treatment Example A 70-kg patient with a plasma bicarbonate concentration of 12 mEqjL would require (70)(24 - 12)(0.3) = 252 mEq sodium bicarbonate. Half of this is 126 mEq |
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Normal Anion Gap is
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(3-11 mEq/L)
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A normal oxyhemoglobin dissociation curve is characterized by 50% saturation of hemoglobin with oxygen at a P02 of '
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26 mm Hg.
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Perioperative fluid therapy includes
3 areas |
(I) replacement of preexisting fluid deficits,
(2) replacement of normal losses (maintenance requirements), and (3) replacement of surgical wound ("third-space") losses (including blood loss) |
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Estimating Maintenance Fluid Requirements
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Up to 10 kg 4 mL/kg/hr
11-20 kg Add 2 mL/kg/hr 21 kg and above Add 1 mL/kg/hr |
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Redistributive and Evaporative Surgical FLuid Losses
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Minimal (herniorrhaphy) 2-4 mL/kg/hr
Moderate (cholecystectomy) 4-6 mL/kg/hr Severe (bowel resection) 6-8 mL/kg/hr |
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fully soaked sponge
soaked "lap" . |
fully soaked sponge ("4 x 4") holds 10 mL whereas a soaked "lap" holds 100 to 150 mL.
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The potassium content of stored blood
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increases progressively with the duration of storage, but even massive transfusions rarely increase plasma potassium concentrations.
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blood and 2,3-Diphosphoglycerate
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Storage of blood is associated with a progressive decrease in concentrations of 2,3-DPG in erythrocytes, which results in increased affinity of hemoglobin for oxygen (decreased P;o values). Conceivably, this increased affinity could make less oxygen available for tissues and jeopardize tissue oxygen delivery. There is speculation that fresh blood (with more oxygen available for tissues) should be used for critically ill patients. Despite these observations, the clinical significance of the 2,3-DPG oxygen affinity changes remains unconfirmed. .
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Administration of FFP should be considered when the
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PT is greater than 1.5 times normal or the INR more than 2.0 and if laboratory tests are unavailable, more than one blood volume (about 70 mL~g) has been given= and excessive microvascular bleeding is present
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Cryoprecipitate should be considered if
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fibrinogen levels are less than 150 mg/dL.
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