How can you assess for fluid volume status?
Skin turgor, mucous membranes, edema, lung sounds, vital signs, UO, HCT, urine specific gravity, BUN/Creatinine
What are the sources of intraop fluid requirements?
Maintenance, fluid deficit, blood loss, evaporative loss (3rd spacing)
How do you calculate maintenance fluids?
4cc/kg/hr for 1st 10kg
2cc/kg/hr for 2nd 10kg
1cc/kg/hr for the remaining kgs
How do you replace the fluid deficit?
1/2 deficit replaced in 1st hour
1/4 in 2nd hour
1/4 in 3rd hour
EBV of neonates, infants, children, and adults
Term neonates: 85ml/kg
Premature neonates: 95ml/kg
Evaporative loss is related directly to ____ and ____
surface area of surgical wound and duration of exposure
How do you account for 3rd spacing evaporative loss?
Minimal loss (eye cases, lap chole, knee scope: 0-2ml/kg/hr
-Moderate loss (open chole, appendectomy): 3-5ml/kg/hr
-Severe loss (bowel surgery, THR): 6-9ml/kg/hr
-Emergency (gun shot, MVC): 10-15ml/kg/hr
What is an example of hypotonic solution? What would it replace?
D5W, these would replace water loss
What is an example of isotonic solution? What would it replace?
LR and NS, these can replace water and electrolyte loss
What is an example of hypertonic solution? What would it replace?
D51/2NS (432) and 3%NS (1026), for hyponatremia or shock
What are some considerations with LR?
Provides 100cc free water per liter of solution, tends to lower Na+, lactate is converted to bicarbonate
Avoid in ESRD as contains K+
What are the two types of Dextran used for?
Dextran 70 used for volume expansion
Dextran 40 used to prevent thrombosis
Side effects of Dextran?
Anaphylactoid reaction (1/3000)
Noncardiac pulmonary edema
Intereference with crossmatching
Hetastarch (Hespan 6%) benefits
As effective as albumin for volume expansion, but way cheaper
What are indications for blood product treatment/transfusion?
Expanding intravascular volume, increasing oxygen carrying capacity, stabilizing hemoglobin and hematocrit
blood transfusion rarely indicated if Hgb>___ and almost always indicated if Hgb<___
Complications of autologous transfusion
-preop myocardial ischemia from anemia
-adm wrong unit (1:100,000)
-Need for more frequent blood transfusion
-Febrile and allergic reactions
Uses for platelets?
-platelet count <50,000
Uses of FFP?
-Emergent reversal of warfarin
-known coagulation factor deficiencies
-correction of microvascular bleeding in the presence of increased PT or PTT
-correction of microvascular bleeding in the pt transfused with more than one blood volume when PT and PTT cannot be obtained in a timely fashion