Podcast
Questions and Answers
What is the formula for calculating the acceptable blood loss (ABL)?
What is the formula for calculating the acceptable blood loss (ABL)?
- ABL = EBV - (Hcti + Hctf)
- ABL = EBV - (Hcti - Hctf)
- ABL = EBV / (Hcti - Hctf)
- ABL = EBV (Hcti - Hctf)/ Hcti (correct)
What is the goal of goal-directed fluid therapy?
What is the goal of goal-directed fluid therapy?
- To achieve a certain blood pressure
- To maintain a certain oxygen saturation
- To maintain a certain heart rate
- To use hemodynamic values to guide fluid administration with fluid responsiveness tested with fluid bolus and relies on the Frank-Starling curve (correct)
What is the purpose of the Frank-Starling curve?
What is the purpose of the Frank-Starling curve?
- To measure cardiac output
- To monitor blood pressure
- To determine fluid responsiveness (correct)
- To assess heart rate
What is the estimated blood loss in a short, uncomplicated laparoscopic procedure?
What is the estimated blood loss in a short, uncomplicated laparoscopic procedure?
What is the primary concern when storing platelets at room temperature?
What is the primary concern when storing platelets at room temperature?
What is the minimum platelet count required before performing a high-risk procedure?
What is the minimum platelet count required before performing a high-risk procedure?
What is the primary components of Cryoprecipitate?
What is the primary components of Cryoprecipitate?
What is the leading cause of death in transfusion complications?
What is the leading cause of death in transfusion complications?
What is the recommended ratio for replacement therapy in massive hemorrhage?
What is the recommended ratio for replacement therapy in massive hemorrhage?
What is the primary concern when giving vasodilatory drugs in a patient with small bowel obstruction?
What is the primary concern when giving vasodilatory drugs in a patient with small bowel obstruction?
What is the primary concern when using starch products as colloids?
What is the primary concern when using starch products as colloids?
What is the advantage of using hypertonic saline over other crystalloids?
What is the advantage of using hypertonic saline over other crystalloids?
Why is LR contraindicated in PRBC transfusion?
Why is LR contraindicated in PRBC transfusion?
What is the primary reason for the left shift in PRBC transfusion?
What is the primary reason for the left shift in PRBC transfusion?
What is the pediatric dose of PRBC transfusion to increase Hct by 10%?
What is the pediatric dose of PRBC transfusion to increase Hct by 10%?
What is the primary reason for not using dextrose-containing solutions in fluid management?
What is the primary reason for not using dextrose-containing solutions in fluid management?
What is the primary indication for using Fresh Frozen Plasma (FFP)?
What is the primary indication for using Fresh Frozen Plasma (FFP)?
What is the half-life of crystalloids in fluid management?
What is the half-life of crystalloids in fluid management?
What is the primary concern when giving vasodilatory drugs in a patient with small bowel obstruction?
What is the primary concern when giving vasodilatory drugs in a patient with small bowel obstruction?
Why is LR contraindicated in PRBC transfusion?
Why is LR contraindicated in PRBC transfusion?
What is the primary reason for the left shift in PRBC transfusion?
What is the primary reason for the left shift in PRBC transfusion?
What is the half-life of crystalloids in fluid management?
What is the half-life of crystalloids in fluid management?
What is the minimum platelet count required before performing a moderate risk procedure?
What is the minimum platelet count required before performing a moderate risk procedure?
What is the estimated blood volume in a preterm neonate and a term neonate ?
What is the estimated blood volume in a preterm neonate and a term neonate ?
What is the most common type of shock in anesthesia?
What is the most common type of shock in anesthesia?
What is the purpose of the Frank-Starling curve?
What is the purpose of the Frank-Starling curve?
What is the primary difference between ERAS and traditional anesthesia?
What is the primary difference between ERAS and traditional anesthesia?
What is the estimated blood loss in a moderately invasive procedure?
What is the estimated blood loss in a moderately invasive procedure?
What is the formula to estimate fluid deficit in a patient?
What is the formula to estimate fluid deficit in a patient?
What is the correct method for administering maintenance fluid and deficit in surgery?
What is the correct method for administering maintenance fluid and deficit in surgery?
What is the estimated blood volume of adults in milliliters per kilogram?
What is the estimated blood volume of adults in milliliters per kilogram?
What is considered moderate surgical blood loss?
What is considered moderate surgical blood loss?
What is the typical blood loss volume in prolonged and highly invasive surgical procedures?
What is the typical blood loss volume in prolonged and highly invasive surgical procedures?
What is true about hypovolemic shock in anesthesia?
What is true about hypovolemic shock in anesthesia?
What are common causes of hypovolemic shock in surgical patients?
What are common causes of hypovolemic shock in surgical patients?
What happens to the contractility of the heart in the Frank-Starling curve when the preload is at the top of the curve and more fluid is added?
What happens to the contractility of the heart in the Frank-Starling curve when the preload is at the top of the curve and more fluid is added?
What is unique about the Frank-Starling curve in heart failure?
What is unique about the Frank-Starling curve in heart failure?
What are the components of ERAS (Enhanced Recovery After Surgery) in anesthesiology?
What are the components of ERAS (Enhanced Recovery After Surgery) in anesthesiology?
What are some the traditional strategies for managing blood loss and fluid management in anesthesiology?
What are some the traditional strategies for managing blood loss and fluid management in anesthesiology?
Which type of acid-base imbalance is associated with the administration of normal saline?
Which type of acid-base imbalance is associated with the administration of normal saline?
What is the primary difference between Lactated Ringer's (LR) and Plasmalyte?
What is the primary difference between Lactated Ringer's (LR) and Plasmalyte?
What is the main difference between crystalloid replacement ratios and colloid replacement ratios?
What is the main difference between crystalloid replacement ratios and colloid replacement ratios?
What is the half-life of colloids?
What is the half-life of colloids?
What are the risks associated with the use of albumin?
What are the risks associated with the use of albumin?
Why would you avoid using lidocaine (LR) in patients with renal or liver disease?
Why would you avoid using lidocaine (LR) in patients with renal or liver disease?
What does one unit of blood do to hemoglobin and hematocrit levels in adults?
What does one unit of blood do to hemoglobin and hematocrit levels in adults?
What is true about the potassium levels in older packed red blood cells (PRBCs)?
What is true about the potassium levels in older packed red blood cells (PRBCs)?
Why would you need to give calcium or bicarbonate during the administration of PRBCs?
Why would you need to give calcium or bicarbonate during the administration of PRBCs?
Why does hematocrit (Hct) change more with hydration status?
Why does hematocrit (Hct) change more with hydration status?
What are the indications for the infusion of concentrates of platelets?
What are the indications for the infusion of concentrates of platelets?
In the presence of thrombocytopenia or platelet dysfunction, what interventions can be done to mitigate bleeding?
In the presence of thrombocytopenia or platelet dysfunction, what interventions can be done to mitigate bleeding?
What is the minimum platelet count before low-risk procedures?
What is the minimum platelet count before low-risk procedures?
What is Platelet Rich Plasma (PRP) and what are the indications for its use?
What is Platelet Rich Plasma (PRP) and what are the indications for its use?
Why is crossmatching more extensive than type and screen testing?
Why is crossmatching more extensive than type and screen testing?
What is TRALI defined as?
What is TRALI defined as?
Is TRALI (transfusion related acute lung injury) more common than anaphylaxis as a transfusion reaction?
Is TRALI (transfusion related acute lung injury) more common than anaphylaxis as a transfusion reaction?
Lowest acceptable Hct (i.e. Hctf) is 21-24 in healthy patients and 30 with CAD
Lowest acceptable Hct (i.e. Hctf) is 21-24 in healthy patients and 30 with CAD
Flashcards
ABL
ABL
Allowable Blood Loss, the maximum amount of blood loss a patient can tolerate without needing a transfusion
EBV
EBV
Estimated Blood Volume, the amount of blood in the body, dependent on age and size.
Hcti
Hcti
Initial Hematocrit, the patient's initial hematocrit value
Hctf
Hctf
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Neonate EBV
Neonate EBV
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Adult EBV
Adult EBV
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Surgical Blood Loss
Surgical Blood Loss
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Hypovolemia
Hypovolemia
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Goal-Directed Fluid Therapy
Goal-Directed Fluid Therapy
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ERAS
ERAS
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Traditional Approach
Traditional Approach
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Small Intestine Fluid
Small Intestine Fluid
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Small Bowel Obstruction
Small Bowel Obstruction
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Crystalloids
Crystalloids
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Colloids
Colloids
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PRBC Transfusion
PRBC Transfusion
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FFP
FFP
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Platelet Concentrate
Platelet Concentrate
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Cryoprecipitate
Cryoprecipitate
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Type and Screen
Type and Screen
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Crossmatch
Crossmatch
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Transfusion Reactions
Transfusion Reactions
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TRALI
TRALI
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TACO
TACO
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Study Notes
Fluid Management and Blood Transfusion
ABL and EBV Calculation
- ABL (Allowable Blood Loss) = EBV (Estimated Blood Volume) x (Hcti - Hctf) / Hcti
- Hctf (Lowest acceptable Hct) is 21-24 in healthy patients and 30 in patients with CAD
- Maintenance fluid rate: 4/2/1 rule
Estimated Blood Volume (EBV)
- Know estimated blood volume by age:
- Neonates: 90-100 mL/kg (premature), 80-90 mL/kg (term)
- Infants: 80 mL/kg
- Adults: 70 mL/kg
- Surgical losses of blood can be 2-8 mL/kg:
- Minimal loss: 0-2 mL/kg (short procedure)
- Moderate loss: 2-4 mL/kg (uncomplicated laparoscopic/orthopedic procedure)
- Severe loss: 4-8 mL/kg (prolonged and highly invasive)
Hypovolemia and Goal-Directed Fluid Therapy
- Hypovolemia is the most common type of shock in anesthesia, but it's also the easiest to fix
- Causes: preoperative fasting, greater fluid loss than fluid replacement
- Goal-directed fluid therapy: uses hemodynamic values to guide fluid administration with fluid responsiveness tested with fluid bolus and relies on the Frank-Starling curve
ERAS vs Traditional Approach
- ERAS (Enhanced Recovery After Surgery):
- NPO guidelines: drink up to 2 hours before
- Purposeful IV fluids
- Opioid-free/sparing techniques
- Regional anesthesia
- Opioid-free adjuncts (e.g., lidocaine, magnesium, precede, ketamine)
- Traditional approach:
- NPO after midnight
- Load fluids in preop and liberal fluids in OR
- Use of opioids for pain control
Fluid in Small Intestines
- Normally, 7-9L of fluid is secreted in the upper GI tract
- Fluid reabsorbed into the large bowel, with only 0.4L passing in the ileocecal valve
- Fluid shifts in small bowel obstruction:
- Early SBO: 1.5L accumulates in bowel
- With vomiting: 3L accumulated
- Hypotension/tachycardia: 6L accumulated (CAUTION when giving vasodilatory drugs)
Crystalloids vs Colloids
- Parenteral fluids:
- Crystalloids:
- Examples: NS, LR, Plasmalyte, normalyte, dextrose in water
- Indications: replace 3:1 in blood loss, half-life of 30-60 mins
- Avoid LR in renal/liver disease due to impaired metabolism/clearance
- Colloids:
- Examples: albumin, dextran, hetastarch, hepsan
- Indications: replace 1:1 in blood loss, half-life of several hours/days
- Risk of allergic reaction and infection with albumin
- Crystalloids:
Transfusing/Different Types of Blood Products
- Human blood:
- RBCs: increase the amount of RBCs
- PRBC transfusion: use filter and fluid warmer, only use normal saline, and avoid LR due to Ca crystallization
- One unit increases Hg by 1g/dL and Hct by 2-3%
- Pediatric dose: 10mL/kg increases Hct by 10%
- Fresh Frozen Plasma (FFP): correct a deficiency in coagulation factors or to treat shock
- Concentrate of platelets: to treat or prevent bleeding due to low platelet levels
- Cryoprecipitate: to treat fibrinogen deficiencies and contains vWF, fibrinogen, fibronectin, FXIII, FVIII
- Platelet Rich Plasma (PRP): platelets, clotting factors, and other plasma proteins
Blood Bank and Transfusion Reactions
- Type and screen: screen for ABO, Rh, antibody, takes 5 mins, and has a 1:1k chance of reaction
- Crossmatch: type and screen plus, takes 45 mins, and has a 1:10k chance of reaction
- Best ratio is 1 RBC:1 FFP: 1 platelets for replacement therapy
- Transfusion reactions:
- TRALI (transfusion-related acute lung injury): more common than anaphylaxis
- TACO (transfusion-associated circulatory overload): leading cause of death in transfusion complications
Fluid Management and Blood Transfusion
ABL and EBV Calculation
- ABL (Allowable Blood Loss) = EBV (Estimated Blood Volume) x (Hcti - Hctf) / Hcti
- Hctf (Lowest acceptable Hct) is 21-24 in healthy patients and 30 in patients with CAD
- Maintenance fluid rate: 4/2/1 rule
Estimated Blood Volume (EBV)
- Know estimated blood volume by age:
- Neonates: 90-100 mL/kg (premature), 80-90 mL/kg (term)
- Infants: 80 mL/kg
- Adults: 70 mL/kg
- Surgical losses of blood can be 2-8 mL/kg:
- Minimal loss: 0-2 mL/kg (short procedure)
- Moderate loss: 2-4 mL/kg (uncomplicated laparoscopic/orthopedic procedure)
- Severe loss: 4-8 mL/kg (prolonged and highly invasive)
Hypovolemia and Goal-Directed Fluid Therapy
- Hypovolemia is the most common type of shock in anesthesia, but it's also the easiest to fix
- Causes: preoperative fasting, greater fluid loss than fluid replacement
- Goal-directed fluid therapy: uses hemodynamic values to guide fluid administration with fluid responsiveness tested with fluid bolus and relies on the Frank-Starling curve
ERAS vs Traditional Approach
- ERAS (Enhanced Recovery After Surgery):
- NPO guidelines: drink up to 2 hours before
- Purposeful IV fluids
- Opioid-free/sparing techniques
- Regional anesthesia
- Opioid-free adjuncts (e.g., lidocaine, magnesium, precede, ketamine)
- Traditional approach:
- NPO after midnight
- Load fluids in preop and liberal fluids in OR
- Use of opioids for pain control
Fluid in Small Intestines
- Normally, 7-9L of fluid is secreted in the upper GI tract
- Fluid reabsorbed into the large bowel, with only 0.4L passing in the ileocecal valve
- Fluid shifts in small bowel obstruction:
- Early SBO: 1.5L accumulates in bowel
- With vomiting: 3L accumulated
- Hypotension/tachycardia: 6L accumulated (CAUTION when giving vasodilatory drugs)
Crystalloids vs Colloids
- Parenteral fluids:
- Crystalloids:
- Examples: NS, LR, Plasmalyte, normalyte, dextrose in water
- Indications: replace 3:1 in blood loss, half-life of 30-60 mins
- Avoid LR in renal/liver disease due to impaired metabolism/clearance
- Colloids:
- Examples: albumin, dextran, hetastarch, hepsan
- Indications: replace 1:1 in blood loss, half-life of several hours/days
- Risk of allergic reaction and infection with albumin
- Crystalloids:
Transfusing/Different Types of Blood Products
- Human blood:
- RBCs: increase the amount of RBCs
- PRBC transfusion: use filter and fluid warmer, only use normal saline, and avoid LR due to Ca crystallization
- One unit increases Hg by 1g/dL and Hct by 2-3%
- Pediatric dose: 10mL/kg increases Hct by 10%
- Fresh Frozen Plasma (FFP): correct a deficiency in coagulation factors or to treat shock
- Concentrate of platelets: to treat or prevent bleeding due to low platelet levels
- Cryoprecipitate: to treat fibrinogen deficiencies and contains vWF, fibrinogen, fibronectin, FXIII, FVIII
- Platelet Rich Plasma (PRP): platelets, clotting factors, and other plasma proteins
Blood Bank and Transfusion Reactions
- Type and screen: screen for ABO, Rh, antibody, takes 5 mins, and has a 1:1k chance of reaction
- Crossmatch: type and screen plus, takes 45 mins, and has a 1:10k chance of reaction
- Best ratio is 1 RBC:1 FFP: 1 platelets for replacement therapy
- Transfusion reactions:
- TRALI (transfusion-related acute lung injury): more common than anaphylaxis
- TACO (transfusion-associated circulatory overload): leading cause of death in transfusion complications
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Description
This quiz covers the formulas and guidelines for estimating blood volume, fluid deficits, and maintenance fluid rates during surgery. Topics include ABL, EBV, and the 4/2/1 rule.
