7. Volume therapy

Question 1

How much blood can you loose and survive w/o fluid substitution?

Answer 1

30%

Question 2

Considerations to take into account when choosing fluid therapy

Answer 2

1) Fluid compartments
2) Starling forces: hydrostatic + osmotic forces
3) Osmotic pressure
4) Oncotic pressure

Question 3

Where will IV fluids go if glycocalyx is injured

Answer 3

Interstitial space (regardless of composition of IV fluid)

Question 4

What are crystalloid solutions?

Answer 4

• A group of solutions containing water-soluble molecules (e.g., saline, dextrose solution)
• Increase intravascular volume

Question 5

Types of crystalloid solutions

Answer 5

1) Hypotonic:
- 5% dextrose (packed as iso, becomes hypo in body)
- 0,45% NaCL
2) Isotonic:
- Normal saline (0,9% NaCl)
- Ringer-lactate
- Ringer
3) Hypertonic:
- 3% saline (NaCl) -> for hypoNa
- 7,5% saline -> for resuscitation

Question 6

What are colloid solutions?

Answer 6

• A high molecular weight substance

- Mostly remains confined to the intravascular compartment and thus generates oncotic pressure

Question 7

Types of colloids

Answer 7

1) Natural
- Human albumin
- Plasma protein fraction
- Fresh frozen plasma
- Ig solutions
2) Artificial
- Gelatin
- HES (limited indication)
- Dextrans (not in Hungary)

Question 8

Indications for human albumin

Answer 8

Sepsis: If volume resuscitation with crystalloids is not sufficient

Question 9

Indication for gelatin

Answer 9

Sepsis

Question 10

When should HES be avoided?

Answer 10

In sepsis

Question 11

If glycocalyx is injured and large volumes is needed for fluid therapy - what do we use?

Answer 11

Crystalloids and colloids (albumin or gelatin - not HES)

Question 12

Haemostasis monitoring (static): plt count and function

Answer 12

1) Plt count (>5x10^9 spon. bleeding is rare)
2) Bleeding time
3) PFA-100 (time needed until obstruction of collagen/epi or collagen/ADP covered membrane pores)

Question 13

Haemostasis monitoring (static): coagulation

Answer 13

1) PT time - INR: II, V, VII, X, fibrinogen
2) aPTT: VIII, IX, XI, XII
3) TT (thrombin time)
4) Plasma fibrinogen
5) D-dimer

Question 14

Complications of blood transfusion

Answer 14

1) Infections
2) Hemolytic reactions
3) TRALI (transfusion associated lung injury)
4) Anaphylaxis