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Exam Review 5 - goi U(0 W1 WW“ 7 8 8" 99°F OR is too...

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Unformatted text preview: goi U (0* W1 WW“ 7. 8. 8" 99°F? OR is too warm many surgical drapes on the pt closed breathing system is being used heat and humidification of inspired gases certain dx states; malignant hyperthermia; thyrotoxicosis; infection; sepsis mechanical devices; thermal blankets, cardiopulmonary heat exchangers, heat lamps, chemical reactions; polymerization of bone cement transfusion reaction malignant hyperthermia can lead to death Dgeafl temp in QR (5) 1. P 3 4. 5 6 uNMNF cool temp in OR semi closed or nonrebreathing circuits used vasodilation and decreased metabolism form inhalational agent prolonged surgical procedure with chest/ abdomen open transfusion with cold blood/IVG or irrigation with cold fluid . exposure Areas gi concern for pafient m 1. Peseeewe head: eyes, ears, lips, tongue, teeth, airway Neck: vasculature, brachial plexus Extremities: nerves, joints, vasculature Skin positioning eyes infection medication and blood administration electrical burns/ other sources of injury Renal linked to hemodynamic status of pt and volume and composition of urine are sensitive indicators of hypovolemia, and deficiencies of CV performance 0.5cc/kg/hr = urine output minimum Fluid Compargnent Water is the most abundant; 421., infants -80%, adult female-45%, male 55%, obese decreased 1. 2. Intracellular fluid = 55% of TBW Extracellular fluid = 45% of TBW A. Interstitial fluid (ISF) 37% TBW fluid That lies in spaces btwn the cells B. Intravascular plasma fluid: 8% TBW, communicates with Awua. Ph 3. Forsectinflui 'lo' nlM interstitial fluid thru pores in capillaries; body‘s main priority is to maintain the intravascular fluid volume C. Transoellular fluid less than 1% TBW, includes csf, intraocular, GI, synovial, pleural fluids ' msf rflui Antidiuretic hormone ADH feedback mechanism; increase reabsorption of water by kidneys, urine produced with range of osmolalitics; hemorrhage, +pressure vent, general anesthesia, harm, pain, hypothermia, barbs stimulate release, alcohol inhibits release Thirst; in hypothalamus, intracellular dehydration, increased osmotic cone of ECF increase Na+. loss of K+, decreased C.O., hemorrhage, dry mouth stimulate Aldosterone: precise control of Na+ excretion; stimulates Na+ reabsorb, promotes K+ secretion, released b/‘c increased K+, ACTH, decrease Na+, increase angiotensin II Renin—Angiotensin; vasoconstrictor, increase SVR, BP, reabsorb Na+ and water, increase blood volume, CD. and ABP atus Temperature; increase increases requirements Metabolic state; hyperthyroidism intake: decreased hypovolemia disease processes; SIADH Body build; fat = decreased body water ElmdMa'mtmaum wwwh Intragperative Fluid Replacement 1. Insensible loss maint: give maint volume; surgical procedure with minute losses, diagnostics, biopsies, short surgeries; 2cc/kg/hr Minor surgical trauma; replace fluids at 4cc/kg/hr plus 2cc/kg/hr= total of écc/kg/hr; tonsillectomy, hernia repair, simple plastic procedures moderate surgical trauma: replace écc/kg/hr plus 2 cc/kg/hr totalsScc/kg/hr, thoracotomy, gastric resection, trunk procedures extreme surgical trauma: Soc/kg/hr plus 2cc/kg/hr total is 10cc/kg/hr; hip ...
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