Critical Care - Review

Question 1

Colors of mucous membranes…

white, blue, red

Answer 1

white = anemic

blue = cyanotic

red = septic

Question 2

***Ddx for patient with red injected mucous membranes and/or injected sclera

Answer 2

Inappropriate vasodilation

**Sepsis!
inflammatory response/shock

Question 3

Petechia on mucous membranes

Answer 3

Severe thrombocytopenia

Question 4

***In acute hemorrhage, TP will drop before ____ due to splenic contraction

Answer 4

TP will drop before PCV

Question 5

***PCV/TP: Anemia

Primary differentials

Answer 5

• loss
• lysis or destruction
• dec production
• sequestration

Question 6

***Why is continuous ECG monitoring commonly employed in CCU

Answer 6

• monitor for post-op arrhythmias
• assess changes in hemodynamic status
• alert uncontrolled pain
• life-check

Question 7

What are the 5 breathing patterns?

Answer 7

1. Tachypnea
2. Shallow, rapid respirations (pleural space dz)
3. Dynamic or Fixed Inspiratory stridor or stertor (upper airway obstruction)
4. Prolonged expiration with expiratory push (lower airway dz)
5. Labored inspiration and expiration

Question 8

***What does dynamic or fixed inspiratory stridor or stertor mean?

Answer 8

Upper airway obstruction

Question 9

***What are Hypotonic Fluids generally used for in practice? Can you use it in emergencies? What do they provide?

Answer 9

Maintenance!

NOT for emergency volumes!

These provide more free water, less sodium, less chloride, and some have maintenance levels of K (if they don’t just add it in)

Question 10

What are Hypertonic fluids good for?

Answer 10

Effective for volume resuscitation to rapidly expand IV space

Question 11

***Evaluating perfusion –> Shock

Answer 11

Inadequate DO2 to or usage (VO2) by tissues to meet their metabolic needs

Question 12

4 Types of Shock

Answer 12

1. Hypovolemic
2. Cardiogenic
3. Distributive
4. Obstructive

Question 13

***Fluid Resuscitation - What amount do we start with?

Dogs?

Cats?

Answer 13

Generally start with 1/8 to 1/4 of historical shock volumes

Dogs = 11-22mL/kg IV bolus

Cats = 8-11 mL/kg

Question 14

***What does Plasmalyte 48 contain? Do we generally use it for anesthetically-induced hypotension?

Answer 14

Contains acetate as a buffer which has been reported to cause hypotension with large, massive infusions 9i.e. dialysis)

Generally avoided for tx of anesthetically-induced hypotension

Question 15

***How do we initially assess CV status (triage)?

Answer 15

• mm color
• CRT
• HR
• pulse quality
• temperature

Question 16

***How do we initially assess respiratory status (triage)?

Answer 16

• rate
• pattern or rhythm
• effort
• dyspnea (inspiratory vs expiratory)

Auscultation

Question 17

***How do we initially assess neuro status (triage)?

Answer 17

• mentation or responsiveness
• body posture
• ambulatory
• CN & PLR

Question 18

***How do we initially assess abdomen (triage)?

Answer 18

• distension
• pain
• fluid wave
• tympany

Question 19

***Polytrauma - What potential complications must be communicated to O?

Answer 19

• TBI
• diaphragmatic hernia
• urogenital trauma/rupture
• pulmonary contusions