Crystalloids
154mEq/L Na+
154mEq/L Cl-
Resuscitation ratio with colloid fluid
1:1
EBL with soaked 4x4 sponge
10mL
Fluid to run in with pRBC
NS
Patient becomes febrile 10 minutes after starting a blood transfusion but remains HDS. Labs are unremarkable with normal lactate and O2 demand is unchanged. What is the cause?
febrile nonhemolytic reaction
LR composition
130 Na
109 Cl
4 K+
3 Ca2+
28 Lactate
major indication for colloid use
or
decreased oncotic pressure
EBL with soaked lap
100-150mL
FFP composition
all coagulation factor except platelets
Condition associated with increased risk of anaphylactic reaction during pRBC transfusion
IgA deficency
Metabolic imbalance from excessive NS infusion
Hypercholemic metabolic acidosis
Intravascular half life
MORE than crystalloids
3-6 hours
Insensible losses during lap to open cholecystectomy
2-4 cc/kg/hr
cryoprecipitate composition
fibrinogen; VIII, XIII, vWF
Patient receiving transfusion while under GA becomes tachycardic, hypotensive and is oozing from IV site. What is the cause?
Acute hemolytic transfusion rxn
140 Na
99 Cl
5 K
3 Mg
Plasma-lyte A
Theoretical risk of viral infection via prion transmission
Albumin
Parkland formula
Volume = %BSA x 4mL/kg x kg
ASA indications for FFP (2/5)
Correction of microvascular bleeding w INR>2
During mass transfusion before labs result
urgent reversal of warfarin
Correction of known factor deficiency when conc unavailable
Heparin resistance (antithrombin III def) requiring heparinization
Patient seen in SICU POD#0 s/p AAA rupture repair. They become febrile and hypotensive. ABG shows hypoxia but normal lactate. No PMHx other than AAA. What is likely the cause
TRALI
Intravascular half life
20-30 minutes
Hetactarch contraindication
Coagulopathy
HF
Renal failure
Maintenance fluid rate for 62kg pt
102mL
ASA indication for cryoprecipitate (2/5)
Fibrinogen <100mg/dL
During mass transfusion when fibrinogen level not available
Bleeding pt with vWD
Congenital fibrinogen deficency
Rarley with fibrinogen <150mg/dL
Mechanism of delayed hemolytic transfusion reaction
Donor RBC Ag