Therapeutics - Fluids 5

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Therapeutics - Fluids 5
2014-02-07 12:44:54
Therapeutics Fluids
Therapeutics - Fluids 5
Therapeutics - Fluids 5
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  1. Why do you not want to give more than a liter of hetastarch?
    Because it can cause dilution of clotting factors
  2. What is Voluven?
    Hydroxyethy starch, a low molecular weight starch for prophylaxis of hypovolunemia
  3. How long will hydroxyethyl starch maintain blood volume expansion?
    For up to 6 hours
  4. How does Hydroxyethyl compare to hetastarch?
    Larger volumes can be used (4L vs 1 L)
  5. What is Hespan?
  6. How does Hetastarch compare to crystalloids/colloids for use in septic shock for fluid resuscitation?
    Higher incidence of acute kidney injury
  7. Why is there concern that Hetastarch may be removed from the market?
    May lead to increased renal injury/dialysis
  8. What is the Cochran review’s stance on Colloids vs. Crystalloids vs. Hetastarch?
    Colloids do not improve survival over crystalloids and hetastarch may cause mortality to increase
  9. Should HES be used in critically ill patients?
  10. Should HES be used in patients with pre-existing renal dysfunction?
  11. How long after HES use should renal function be monitored?
    90 days
  12. Why should HES not be used in open heart surgery or with cardiopulmonary bypass?
    It causes excessive bleeding
  13. What are dextrans?
    Polysaccharide plasma expanders, glucose solution with colloidal activity and pulls fluid from the interstitium to the intravascular space
  14. What is Gentran?
    A dextran plasma expander
  15. What is the difference between Dextran 40 and 70?
    Molecular weight of the polysaccharide
  16. What are the adverse effects of dextrans?
    Anaphylactic sock and prolonged bleeding
  17. Can you use Dextrans for DVT prophylaxis?
  18. Why is fresh frozen plasma beneficial for excessive bleeding?
    It has a lot of clotting factors
  19. Does Fresh frozen plasma contain platelets?
  20. Does fresh frozen plasma contain fibrinogen?
  21. How does fresh frozen plasma effect BP?
    Increases colloidal oncotic pressure and moves fluid into the vascular space
  22. What are the risks of fresh frozen plasma?
    Anaphylaxis, potential viral transmission, hepatitis and increased nosocomial infection rate in the ICU
  23. Is Fresh frozen plasma used as a volume expander?
  24. What are the benefits of using oxygen carrying resuscitation solutions?
    Increase plasma oncotic pressure and improve tissue oxygenation
  25. What is the rule of thumb for giving oxygen carrying resuscitation solutions?
    Hemoglobin less than 7 or previous ischemic disease and their hemoglobin is less than 8
  26. What are oxygen carrying resuscitation solutions?
    Packed whole red blood cells o whole blood
  27. What are the main areas of complication with IV therapies?
    Infiltration, Infection, Phlebitis, Thrombophlebitis and Extravasation
  28. What is infiltration?
    Non-vesicant fluid leaks into the surrounding tissues
  29. What is Phlebitis?
    Inflammation of the vein
  30. What is Thrombophlebitis?
    Irritation of the vein with clot formation
  31. What is extravasation?
    Leakage of vesicant fluid into the surrounding tissue
  32. What is the key to choosing a fluid type?
    Defining the primary type of fluid problem, TBW or ECF
  33. What is the standard therapy to treat impaired tissue perfusion?
    Rapid infusion of NS (150 to 500 mL/hr), when patient does not present with s/s of reduced tissue perfusion, switch to hypotonic solution at normal rate
  34. How can you monitor a fluid therapies effects?
    Weight changes, physical s/s, orthostatic BP, pulse rate, blood chemistries, ins and outs, CVP, PCWP and CO
  35. What conditions may predispose a patient to fluid overload and thus need cautious fluid replacement?
    Renal, Cardiac or hepatic failure and the Elderly
  36. Why might a patient with renal disease be predisposed to fluid overload?
    Inadequate output
  37. Other than, liver kidney or cardiac issues, what are causes of inadequate output of fluids?
    Low dietary protein, steroid use and HYPERaldosteronism
  38. Can administration of blood or plasma cause fluid overload?
  39. Can remobilization of edema cause fluid overload?
  40. What are the normal causes of inadequate oral intake of fluids?
    Dementia, Neglect or CVA
  41. What are metabolic causes of fluid deficits?
    DM and insipidus
  42. Can poor IV access cause inadequate fluid replacement?
  43. What is the best IV fluid for a 35 year old male with septic shock?
    0.9% saline
  44. What is the best IV fluid for a 47 year old female with upper GI bleeding and requires a transfusion?
    0.9% saline (with blood)
  45. What is the best IV fluid for a Non-diabetic with chest pain, hypotensive but other vistal signs are stable?
    0.9% saline
  46. An eldery women with a fluid deficit due to inadequate intake is admitted to the hospital and put on a NG suction, how would you correct her fluids?
    Calculate her deficit, return half the deficit the first day and then the second half with the first 48 hours, account for the NG suction loss
  47. What is the first step of assessing a patient for Fluid needs?
    Assess volume status
  48. After you have assessed the volume status of patient and find an issue, what should you do?
    Evaluate the type of volume issue at hand (hypo/hypercolemic, preprocedure or NPO, healthy there for elective reasons)
  49. If a patient is going in for a procedure or is NPO, what type of fluid will they likely get?
  50. What is the most likely fluid to be chosen for a patient with Hypovolemia?
  51. What fluids are usually considered “correction fluids” and thus would be used for resuscitation?
    NS, LR and hypertonic saline
  52. What fluids are normally considered “Maintenance fluids”?
    D5W, D51/2NS and D51/4NS