Cardiovascular Module 1 Flashcards
How do you assess perfusion status
- HR
- MM color
- CRT
- Pulse amplitude and duration
- Peripheral pulses
What are the 4 types of shock
- Hypovolaemic
- Cardiogenic
- Obstructive
- Distributive
What are advanced assessments of shock
- Blood pressure
- CVP
- Lactate
- oxygen extraction ratio
What is arterial blood pressure and how can is it measured
The vascular tone that propels blood through the vascular arterial system
1. Direct measurement: catheter to peripheral artery
2. Indirect measurement: Oscillometric and doppler
What are the pros and cons of oscilometric measurement
Pros: MAP, sys and dia, easy, non-invasive, Cons: tends to read low, cant use if arrhythmias, no in small dogs or cats and tremblers
What are the pros and cons of doppler measurement
Pros: can use in small dogs and cats, can use with arrhythmias, audible signal, mobile, non-invasive
Cons: only systolic, technical
What is CVP and 4 ways to measure
Central venous pressure: measurement of hydrostatic pressure within the central venous compartment (assessment of vascular filling)
Normal CVP 0-5cmH20
Can use trend to measure fluid therapy
Measurement
1. Pulmonary arterial catheter - measures CO in different chambers of the heart at different points in cardiac cycle
2. LiDCO - lithium dilution
3. PulseCo - waveform of pulse to calculate CO, needs to be calibrated with thermodilution or LiDCO
4. Thoracic Electrical Biompendance
What is the oxygen extraction ratio and how can it tell you about perfusion
There is a period of time within shock where perfusion is maintained by increasing how much oxygen in extracted from Hb - this results in a decreased venous O2 saturation
- early marker
What are resuscitation endpoints with hypovolaemic and distributive shock
fluids
BP sys 100-120, mean 80-100
Bicarb: 20-24mmol/L
Lactate: <2 dogs and <1.4 cats
Urine output: 0.5-1ml/kg/hr
Hypovolaemic treatment options
- Isotonic crystalloids - 5-10ml/kg/hr cats and 5-30ml/kg/hr and reassess
- Hypertonic saline
- Colloids - expand vascular volume, SE
- Human albumin - can cause anaphylaxis
What causes SIRs
Inflammatory stimulus so strong that pro-inflammatory facotrs are no longer locally confined and spill over into systemic circulation leading to body wide activation of inflammatory cascade with vasodilation and leaky vessels
What criteria is required to classify as SIRs
Needs 2 or 4 criteria
1. Hypothermia (<37.8), hyperthermia (>39.4)
2. Tachycardua >140bpm
3. Tachypnoea >20bpm
4. Leucopenia (<6000 cell/uL) or Leucocytosis (>16,000 or >3% band neuts)
Treatment protocol for sepsis
- Diagnosis - find the cause
- Antibiosis
- Fluid therapy
- Vasoactive agents
- Monitor for organ dysfunction
- Physiological steroid therapy
What is the best protocol for respiratory distress?
- Oxygen
- Minimal handling
- Quiet environment
- Sedate
- Observe resp pattern
What are the 5 resp patterns
- Inspiratory: long slow inspiratory phase,
stertor/stridor - URT obstruction, LP,
Nasopharyngeal disease - Restrictive: Rapid, shallow pattern - even exp/insp
- pleural effusion, pleural edema,
pneumo - Obstructive: expiratory push - LRT - Asthma,
Bronchitis, Neoplasia - Paradoxical: Thorax and abdomen move in
opposite directions - diaphragmatic
hernia, resp fatigue - Mixed (cats): Cats - pleural effusion
