Critical Care

Question 1

Prognostic indicator in GDV

Answer 1

Lactate >9mmol/l 50/50 chance of survival

Lactate >6mmol/l correlated with gastric wall necrosis

Question 2

Arrhythmias during GDV, when to treat and how to treat

Answer 2

Ventricular arrhythmia
Deteriorates to ventricular fibrillation

When to tx:
Reduced bp
R on t
Multiform complexes

How:
Lidocaine 2mg/kg followed by CRI 50mg/kg/min

Question 3

Dose of whole blood transfusion and how much does PCV increase by?

Answer 3

10-25ml/kg

2ml/kg increases PCV by 1%

Question 4

Dose of packed RBCs and how much will raise PCV?

Answer 4

6-10ml/kg over four hours

2ml/kg will raise PCV by 2%

Question 5

Fresh frozen plasma dose for coagulation defects

Answer 5

20ml/kg over 3-4 hours and then recheck clotting times. May need repeated
Thaw in water bath not > 37degrees as will denature proteins

Question 6

What is cryoprecipitate and dose

Answer 6

Prepared from thawing FFP at -0.6degrees and plasma centrifuged off

Contains factor VIII, vWF and fibrinogen

Same coagulation ability as FFP and more appropriate I’d limit volume required

Dose one unit per 10kg

Question 7

Cryo-poor plasma

Answer 7

Contains vitamin k dependant factors

II, VII, IX, X

Useful in rodenticide toxicity

Question 8

Platelet rich plasma

Answer 8

Centrifuges from fresh whole blood centrifuged at a slower rate and platelets resuspended in small volume of plasma
Life span 4-5 days

The transfusion lasts only 24 hours as most of platelets removed by spleen

Limited clinical effect

Question 9

Dose of hypertonic saline

Answer 9

Check

Question 10

Dose of colloids

Answer 10

Check

Question 11

Dose of fluids for hypovolaemia

Answer 11

Check but 20ml/kg over 20 minutes initially

Question 12

Dose of FFP for rodenticide toxicity

Answer 12

20ml/kg

Question 13

Effects of metaldehyde toxity

Answer 13

Restlessness, anxiety, twitching and seizures

Green vomit / faeces

Can develop kidney injury due to myoglobin release

Question 14

Treatment of bromethalin toxicity

Answer 14

Emesis if <4h since ingestion
Activated charcoal

If symptomatic tx cerebral oedema w mannitol, steroids, furosemide

Question 15

Diagnosis of cholecalciferol toxicity (vitamin D)

Answer 15

High levels of calcifediol (15x normal) this is the primary metabolite of vit D

High phosphorous
Hypercalcaemia
Low PTH

Isostheunuria, casts, mineralisation of kidneys and tissues etc, azotaemia

Question 16

Toxicities for which IV lipid emulsion can be used as an antidote for

Answer 16

Ivermectin
Moxidectin
Cholecalciferol
Amlodipine
Baclofen
Marijuana
Permethrin
Phenobarbital
Propranolol
Tricyclics antidepressants

Question 17

Resting energy requirements

Answer 17

Patients < 30kg:
(30xBW) + 70. Kcal

> 30kg
70 x BW^0.75

Question 18

What is refeeding syndrome

Answer 18

Sudden release of insulin:

Hypokalaemia (neuromuscular dysfunction)

Hypophosphataemia (haemolysis)

Hyponagnesaemia (cardiac arrhythmias)

Azotaemia

Question 19

Complications associated with parenteral nutrition

Answer 19

Hyperglycaemia
Sepsis
Lipaemia
Azotaemia