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TnJ > 6 > Flashcards

6 Flashcards

1
Q

what does oxygen delivery depend on

A

oxygen delivery DO2DO2 = CO x CaO2CO cardiac output = SV x HRCaO2 arterial oxygen content

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2
Q

body’s compensatory response to tissue hypoxia

A

tachycardiatachypneaperipheral vasoconstrictionmental depression

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3
Q

common classifications of shock

A
  1. Hypovolemic–reduced volume, reduce preload, reduce SV, reduced CO2. Cardiogenic–inability of heart to contract/propel fwd3. Distributive–impaired mx of vascular tone and relative hypovolemia4. Hypoxic–adequate perfusion but inadequate oxygenation
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4
Q

major determinant of arterial oxygen content

A

amount of HbCaO2= (Hb x SaO2 x 1.34) + PavO2 x 0.003

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5
Q

What does CO depend on

A

CO = SV x HrSV = preload, after load and contractility

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6
Q

preload

A

end diastolic volumeincr preload will incr stretch and incr contractility to a point (Frank Starling mx)

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7
Q

afterload

A

ventricular wall tension or resistance the muscle needs to counter during systoleinfluenced by vascular resistance (low BP is the major determinant of decr after load)

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8
Q

contractility

A

force and velocity of cardiac muscle contraction

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9
Q

what is blood flow influenced by

A

assumes blood flow is uniform across tissue bedsbutinfluenced by vasomotor controlcirculating blood volumeactivation of blood components

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10
Q

types of hypovolemic shock

A

blood lossburnssevere diarrhea, vomitingthird spacing

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11
Q

types of cardiogenic shock

A

systolic dysfx–CHF, DCM, arrythmias, valvular stenosis/insufficiencydiastolic dysfx–HCM, cardiac tamponade, pericardial fibrosis, tension pneumothorax (sometimes referred to as obstructive shock)

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12
Q

types of distributive shock

A

sepsisanaphylaxisneurogenicdrugs–anesthetics

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13
Q

types of hypoxic shock

A

hypoxemiaanemiamethemoglobinemiaCO poisoning cytopathic (cells aren’t able to produce energy from O2 available)

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14
Q

what is Hb affinity for oxygen dependent on

A

pHtemperature2,3-diphosphoglycerate (DPG)CO2

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15
Q

equation for mean arterial BP

A

MAP = DAP + 1/3 (SAP-DAP)

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16
Q

decreases in tempincreases in pHdecreases in pCO2decreases in 2,3 DPG

A

shift oxygen-HB dissociation curve to the LEFTmaking oxygen less available/delivery of less oxygenincreases Hb affinity for oxygen

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17
Q

increases in tempdecreases in pHincreases in pCO2increases in 2,3 DPG

A

shift oxygen-Hb dissociation curve to the RIGHTmaking oxygen more available/delivers more oxygendecreases Hb affinity for oxygen

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18
Q

tissue hypoxia results from

A

Decreased PaO2/SaO2Impaired DO2Decreased COreduction in Hb

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19
Q

what is the main determinant of tissue perfusion

A

CO=SV x HR

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20
Q

three main abnormalities that will result in low CaO2 (arterial oxygen content)

A

–anemia–altered Hb fx–hypoxemia

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21
Q

oxygen uptake eqn

A

oxygen uptake VO2; rate at which oxygen leaves HbVO2 = CO x (CaO2-CvO2)FICK equation

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22
Q

if all oxygen available is delivered to tissue and is utilized, how much O2 should remain bound to Hb in venous supply?

A

If oxygen delivery is adequate, sufficient O2 should remain in venous blood to provide at least 70% saturation of Hb

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23
Q

oxygen extraction ratio

A

ratio btwn oxygen supply and utilization or oxygen delivery and uptakeO2ER= VO2/DO2 x 100

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24
Q

DO2/VO2 curve and the anaerobic threshold

A

over a wide range of values, VO2 is INDEPENDENT of DO2if DO2 starts to decrease, eventually it hits critical DO2 point or the anaerobic threshold where now VO2 is DEPENDENT on DO2 and below this threshold anaerobic mechanisms ensue.

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25
Q

defects in oxygen uptake

A
  1. diffusional shunting: slow velocity blood, favors oxygen diffusion, less oxygen delivered to target tissues2. diffusional resistance: tissue edema impairs oxygen diffusion to tissues3. AV shunting: low of normal flow and bypass occurs leading to increase oxygen content in venous blood supply4. Perfusion/metabolism mismatch: delivery of oxygen is adequate but it is not taking up by diseased tissue5. cytopathic/metabolic dysfunction: intracellular interference with oxygen/aerobic metabolism
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26
Q

major sources of lactate

A

musclegastrointestinal tract

27
Q

Why does the body switch to anaerobic mechanism

A

when DO2 can not meet tissue demandsswitch to anaerobic metabolism to save ATPglucose –>pyruvate —>lactate (via LDH)generates NAD+ but saves ATPwhen oxygen returns ATP can be used to lactate–>pyruvate–>glucose

28
Q

arterial blood pressure eqn

A

ABP = CO x SVR

29
Q

absence of a peripheral pulse vs absence of femoral artery pulse in relation to BP

A

lack of peripheral pulse SAP 80 mm Hglack of femoral pulse SAP < 60 mm Hg

30
Q

shock organ in dog vs cat

A

GI doglung cat

31
Q

T/F arterial BP is synonymous with perfusion

A

FALSEABP does not equal perfusionnormal ABP does not rule out hypo perfusion.low BP is not SN and late marker of uncompensated state and failure of SNS

32
Q

minimum BP o maintain major body systems

A

MAP 60SAP 90

33
Q

disadvantages to arterial catheters

A

technically challenging, time consuminghematoma formationthrombosis hemorrhageinflammationnecrosis distally (cats)

34
Q

advantages of arterial catheters

A

GOLD std for BP monitoringcontinuous or intermittent readingsMAP, SAP, DAP

35
Q

Doppler BP monitoring only reliably monitors what

A

ONLY SAPbetter than oscillometric methods (which underestimate)in anesthetized cats, doppler may more accurately represent MAP

36
Q

normal CVP

A

0-5 cm H20most closely represents end diastolic volume

37
Q

how many mm Hg in one cm H20

A

0.74 mm Hg in 1 cm H20

38
Q

common causes of increased CVP

A

right heart failurevolume overloadpericardial effusionpleural space diseaseincreased intrathoracic pressure

39
Q

gold standard for cardiac output measurements

A

thermodilutionSwan Ganz pulmonary arterial catheter(other methods lithium dilution, transpulmonary thermodilution–minimally invasive)

40
Q

normal lactate

A

indicator of hypoperfusion normal < 2 mmol/Lmonitor trendsmay be prognostic indicator

41
Q

difference between type A and type B lactic acidosis

A

type A: inadequate DO2 (most common)type B:adequate DO2 w hyperlactatemia from mitochondrial dysfunction

42
Q

cyanosis of blue MM indicates

A

> 5 g/dl of deoxygenated Hb in circulation

43
Q

pulse oximetry is influenced by

A

pigmenthypothermiavasoconstrictionperipheral hypoperfusionmovementambient light

44
Q

rough estimate of the relationship if PaO2 and inspired oxygen

A

PaO2 should be ~5x FIO2ex 21% oxygen in room air x 5 = > 90 mm Hg

45
Q

what does FAST stand for

A

focused assessment with sonography for trauma

46
Q

at what rates does oxygen toxicity occur

A

FIO2 > 60% for more than 24 hours

47
Q

unilateral vs bilateral nasal cannulas for oxygen supplementation at flow rate 100 ml/kg/min

A

unilater 40%bilateral 60%

48
Q

methods of oxygen suppementation

A

flow by +/- ecollar/wrapnasal/nasopharyngealtracheal

49
Q

common sites for IVC

A

jugular veinsperipheral veins (avoid hind in severe shock patients–GDV)intraosseous (trochanteric fossa, prox humerus, tibial crest)

50
Q

inotropic support with dopamine (low, med, hi doses)

A

low 0.5-2.0 mcg/kg/min vasodilationmed 2-10 mcg/kg/min Beta receptors inotropic/contractilityhigh 10-20 mcg/kg/min vasoconstriction, alpha receptors

51
Q

what is dobutamine avoided in cats

A

seizures in cats more beta specific inotrope

52
Q

T/FSIRS may be infectious and/or noninfectious

A

TRUE

53
Q

difference btwn SIRS and sepsis

A

SIRS–noninfxn and infxn causesmost common cause of SIRS is sepsissepsis –SIRS with infxn

54
Q

septic shock definition

A

sepsis (SIRS with infxn) and state of acute circulatory failure

55
Q

MODs

A

multiple organ dysfunction syndrome

56
Q

ARDs

A

acute respiratory distress syndrome

57
Q

diagnostic criteria for ARDS

A
  1. acute onset < 72 hr tachypnea/labored breathing2. presence of risk factors3. pulmonary capillary leak without increased pressure4. inefficient gas exchange5. diffuse pulmonary inflamation
58
Q

ALI vs ARDS

A

ALI is less severePaO2/FIO2 ratio< 300 ALI< 200 ARDS

59
Q

5 causes of hypoxemia

A
  1. hypoventilation2. low inspired oxygen FIO23. VQ mismatch4. AV shunting5. diffusion impairment
60
Q

septic foci in dogs vs cats

A

GI (most common in dogs)repro (dog >cat)pleural space (cats>dogs)endocarditispancreatitisurinary tract nosocomial (check IVC)

61
Q

T/F mortality can be as high as 80% with inappropriate use of Ab to treat sepsis

A

TRUE

62
Q

describe de-escalation therapy

A

start Ab approach broad (4 quad–gm + gm - anaerobic, aerobes)then taper/narrow therapy once C&S available

63
Q

adrenal insufficiency and septic shock

A

aka critical illness related corticosteroid insufficiencycortisol levels may be high or normal but adrenal response is bluntedleads to refractory hypotensiontx low dose physiology GCC (hydrocortisone)

TnJ (128 decks)

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