Approach to a Dyspneic Patient + Fluid Resuscitation Flashcards
What are ways O2 can be supplemented?
- Flow by
- Face mask
- O2 cage
- Nasal O2 canula (high O2 flow)
- Intubation + manual or mechanical ventilation
__________ is a form of noninvasive ventilation with high O2 flow rates of 1-2 L/kg/min
High flow nasal cannula
What POC diagnostic test can help differentiate between CHF vs primary respiratory tract disease?
- Brain natriuretic peptide (proBNP)
- POC ultrasound to check for B lines or atrial enlargement (Indicates heart issue)
What is the approximate blood volume in dogs and cats (mL/kg)
Dogs: 80-90 mL/kg
Cats: 60 mL/kg
____% dehydration results in significant hypovolemia and can be fatal
10-12%
How can interstitial dehydration be assessed?
- MM moisture
- Skin tent response
- Eye position and corneal moisture
- Hemoconcentration (PCV)
- USG
How can intravascular dehydration be assessed?
- MM color, CRT, HR, pulse quality
- Lactate
- Blood pressure
Which of the following cannot be assessed on physical exam?
A. Interstitial dehydration
B. Intravascular dehydration
C. Intracellular volume
C. Intracellular volume
What are signs of overhydration and risks of fluid overload?
- Chemosis
- Serous nasal d/c
- Interstitial edema
- Ascites
- Pleural effusion
- Pulmonary edema
Which of the following is true about giving a fluid bolus?
A. Used to treat hypovolemia
B. Used to treat dehydration
A. Used to treat hypovolemia
Fluid bolus not indicated for tx of dehydration
What is the approximate maintenance rate in dogs vs cats vs neonates (mL/kg/d)?
Dogs: 60-66 mL/kg/d
Cats: 40-50 mL/kg/d
Neonates: 80-200 mL/kg/d
What is a “shock dose” of IV fluids?
- Shock dose is based on the approx blood volume of the animal
(Dogs: 80-90 mL/kg, Cats: 60 mL/kg)
1/4-1/3 of the shock dose is given
If a patient initially had a lactate of 6, and now it is 2. What does this mean?
Perfusion is improving and anaerobic glycolysis is decreasing
Known as lactate clearance
List the unbuffered fluid solutions
- 0.9% NaCl
- 0.45% NaCl
- DSW (5% dextrose in water)
Which of the following is not a measure to assess intravascular dehydration?
A. CRT
B. Pulse quality
C. Skin tent response
D. Lactate levels
C. Skin tent response
What does “buffered” fluids vs unbuffered fluids mean?
Buffered fluids have lactate, acetate or gluconate that act as buffers
D5W and NaCL solutions are unbuffered
What is the maintenance rate for the following
Dogs:
Cats:
Pediatric/Neonates:
Dogs: 60-66 mL/kg/d
Cats: 40-50 mL/kg/d
Pediatric/Neonates: 80-120 mL/kg/d
Convert 25kg to liters
25kg=25L
What is the shock dose for a 6kg adult dog?
- Based on blood vol (80-90 mL/kg)
- Give 1/4-1/3 shock dose
- 1/4 shock dose of 80 = 20mL/kg
- 20 mL/kg x 6kg = 120 mL shock dose
What is the shock dose for a 3 kg cat?
- Based on blood vol (60 mL/kg)
- Give 1/4-1/3 shock dose
- 1/4 shock dose of 60 = 15mL/kg
- 15 mL/kg x 3kg = 45 mL shock dose
What fluid would you give in a hyperkalemic, Hypercalcemic patient?
0.9% NaCl
What are the common buffers found in IV fluids?
- Lactate
- Acetate
- Gluconate
Hypovolemia is a loss of fluid from the ___________ space
intravascular
Dehydration is a loss of fluid from the ___________ space
Interstitial and intracellular
What does the presence of B lines indicate?
Interstitial lung fluid (edema, hemorrhage)
What is the fluid of choice for an Addisonian patient?
(Low Na, High K)
- Give 0.9% NaCl
True or False: Metabolic acidosis should be treated with crystalloid fluids that contain a buffer
True
(Ex: DKA, Lactic acidosis, uremia, ethylene glycol toxicity = give LRS, Plasmalyte R or Norm R)
Dextrose containing fluids are limited to patients with __________
- Severe hypernatremia
- Patients that can’t tolerate high levels of sodium (Heart failure)
- Hyperaldosteronism
What fluid would you give to a blocked cat with hyperkalemia?
0.9% NaCl
