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Shock / CPR > Diagnosis / monitoring > Flashcards

Diagnosis / monitoring Flashcards

1
Q

What is the normal fractional shortening in dogs and cats

A

Dogs: 28-45%
Cats: 30-50%

<20% -> suggestive of severe systolic failure

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2
Q

What are the 5 sites of the abdominal POCUS and what organs do they show

A
  • Subxiphoid (=diaphragmatico-hepatic) -> diaphragm, gallbladder, liver, ventral stomach
  • Umbilical -> gravity-dependent body wall, intestines, spleen
  • Urinary bladder (cysto-colic) -> urinary bladder, gravity and non-gravity-dependent body walls
  • Right paralumbar (hepato-renal) -> right caudal liver lobe, right kidney, body wall, duodenum
  • Left paralumbar (spleno-renal) -> spleen, left kidney, intestines, body wall

Recommend to fan and rock the probe through 45° angles at each site

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3
Q

What is the normal frequency of gastric or duodenal peristaltic contractions observed on POCUS in a non-fasted dog

A

4-5 contractions per minute

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4
Q

List 4 causes of loss of lung sliding on POCUS

A
  • Non-ventilated lung (one-lung intubation)
  • Pleural space disease (pneumothorax, pleural effusion, diaphragmatic hernia)
  • Severe lung consolidation
  • Pleural adhesion
  • Severe lung hyperinflation
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5
Q

How to calculate urine volume based on bladder measurement

A

Vurine (mL) = [L * W * (dl + DT)/2] * 0.52

L = length in longitudinal
W = width in transverse
dl = depth in longitudinal
DT = depth in transverse

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6
Q

Name 3 characteristics that are always present with B-lines

What can B-lines be confused with?

A
  • They are vertical white lines
  • They originate at the lung surface
  • They move with the pleura
  • Z-lines: do not move with the breathing, do not erase A-lines, usually disappear after 2-5cm
  • I-lines: look like B-lines but do not extend to the far field
  • E-lines: originate from SQ space (caused by SQ emphysema) and obliterate pleural line
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7
Q

Name the cardiac POCUS views

A
  • Long axis right parasternal four-chamber view
  • Right parasternal short axis transventricular view
  • Right parasternal short axis transaortic view
  • Subxiphoid view
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8
Q

What are the asynchronous and the double curtain signs?

A

Asynchronous curtain sign: movement of the vertical edge in the opposite direction of the abdominal contents or minimal movement of the vertical edge while abdominal contents move caudally

Double curtain sign: 2 vertical air to soft tissue interfaces visible in the same sonographic window, which disappear without sliding caudally from the ultrasound image

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9
Q

What is a lung point?

A

Point of contact between the visceral and parietal pleura in cases with pneumothorax. Its presence confirms pneumothorax with confidence, but it can be absent in severe pneumothorax.

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10
Q

What are 2 diagnostic criteria for alveolar interstitial syndrome?

A
  • Presence of >3 B-lines
  • Coalescing B-lines
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11
Q

What 2 criteria are required for the presence of a Gide sign and name 5 causes of absence glide sign.

A
  • The patient must take a breath
  • The pleural sheets must be in contact
  • Pneumothorax
  • Pleural masses
  • Effusion
  • Apnea
  • Adhesions
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12
Q

True or false: air bronchograms are present on POCUS assessment of PTE

A

False - usually absent with nodule sign and PTE

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13
Q

What is the normal CVC collapsibility index in a spontaneously breathing patient

A

25-50%

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14
Q

Fill in the blank: A feline left atrium bigger than ____ mm at the end of ventricular systole is considered enlarged.

A

16.5mm

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15
Q

What are the determinants of SvO2

A
  • CO
  • Hb concentration
  • SaO2
  • VO2 (oxygen consumption)
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16
Q

What rectal-interdigital temperature gradient is highly suspicious for shock in dogs

A

11.6°F (Sp 90% but low Se ; best cut-off was 8.5°F but Sp was lower)

Interdigital temperature measured between the 3rd and 4th digit of pelvic limb

17
Q

What is the shock index? What value is suggestive of shock in dogs and cats?

A

SI = HR/SBP

Dogs: SI>1.0 suggestive of shock, cats: SI>1.6

18
Q

What point-of-care analysis of abdominal effusion would be suggestive of:
- septic peritonitis
- uroperitoneum
- bile peritonitis

A

Always comparing effusion vs peripheral

  • Septic: lactate difference > 2 mmol/L, glucose difference > 20 mg/dL (1.1 mmol/L)
  • Uro: creatinine ratio > 2:1, potassium ratio > 1.4:1 in dogs or 1.9:1 in cats
  • Bili: bilirubin ratio > 2:1
19
Q

What is Kirby’s rule of 20

A

Monitoring parameters for critically ill small animal patients:
- Fluid balance
- Oncotic pull
- Glucose
- Electrolyte and acid-base balance
- Oxygenation and ventilation
- Mentation
- Perfusion and BP
- Heart rate, rhythm, contractility
- Albumin
- Coagulation
- RBD and Hb
- Renal function
- Immune status, antibiotic dosage
- GI motility and mucosal integrity
- Drug dosages
- Nutrition
- Pain
- Nursing care, mobilization
- Wound care
- Tender loving care

20
Q

Name 2 scores that can be used for prediction of mortality in patients presented after trauma

A
  • ATT (Animal Trauma Triage) score
  • mGCS (modified Glasgow Coma Scale)
21
Q

What categories of parameters does the ATT score assess

A

Perfusion, cardiac, respiratory, eye/integument/muscle, skeletal, neurological

(Each graded 0-3, most severe being 3)

22
Q

What are the parameters assessed in the canine APPLEfull (10) and APPLEfast (5) scores

A

APPLEfull: creatinine, bilirubin, age, SpO2, mentation score, fluid score, albumin, lactate, WBC, RR

APPLEfast: glucose, albumin, lactate, platelet, mentation score

23
Q

What are the parameters assessed in the feline APPLEfull (8) and APPLEfast (5) scores

A

APPLEfull: mentation score, T, MAP, lactate, PCV, urea, chloride, fluid score

APPLEfast: mentation score, T, MPA, lactate, PCV

24
Q

What are the normal values for lactate in dogs and cats

A

Dogs: 0.3-2.5 mmol/L (can be higher in puppies)
Cats: 0.3-2.8 mmol/L (one study up to 5.4 mmol/L)

25
Q

In what sample is lactate commonly measured

A

Often measured in plasma although the sample put in the machine is whole blood. Plasma lactate is usually a little lower than whole blood lactate since RBC contain about 70% of the amount of lactate found in plasma

26
Q

What are precautions to take when measuring lactate in a patient

A
  • Avoid struggling and prolonged compression of vein
  • Analyze sample within 15 min (cells will continue glycolysis in the sample)
  • Ideally use lyophilized heparin to avoid dilution effect
  • If sample being sent to external lab, use sodium fluoride (glycolytic inhibitor)
  • Citrated tubes should be avoided
  • Can use central vein, peripheral vein or artery, but should use the same site to trend
27
Q

What toxin can interfere with lactate measurement

A

Ethylene glycol (metabolites glycolic acid and glyoxalic acid can be measured as lactate)

28
Q

At what rate should lactate decrease if resuscitation is efficient

A

Half life = 20-60 min -> decrease by 50% every 1-2 hours and resolution within 6-12 hours

29
Q

Name a few blood parameters than can be assessed via an IO sample (and 2 that can’t)

A

BUN, TS, bilirubin, Na, Cl, glucose, blood gases (similar to central venous).

K and PCV/Hct not always reliable.

Acid-bases reliable for 15 min during CPR

30
Q

What can be measured to assess ischemia-reperfusion injury

A

Malondialdehyde and isoprostanes (indicate lipid peroxidation)

31
Q

How does ATT score predict mortality in patients with trauma

A

Likelihood of survival decreases by 2.07 times for each point increased

ATT>5 predicts death with Se 83% and Sp 91%

32
Q

How does the MGCS predict mortality in dogs with head trauma

A

MGCS<11 predicts death with Se 84% and Sp 73%

33
Q

The venoarterial CO2 difference can be used to identify patients who are under resuscitated. What value suggests an insufficient blood flow, even when ScvO2 is >70%?

A

pCO2 gap of > 6mmHg

34
Q

Explain how CO, Hb concentration, O2 saturation, body temperature, shunting and oxygen utilization will affect SvO2

A
  • High CO = increased SvO2
  • Low CO = decreased SvO2
  • High Hb = increased SvO2
  • Low Hb = decreased SvO2
  • High temp = decreased SvO2
  • Low temp = increased SvO2
  • Shunting = increased SvO2
  • Decreased O2 utilization (sepsis, cyanide toxicity) = increased SvO2
35
Q

True or false: a low lactate is a better predictor of survival than a high lactate is of death.

A

True

Shock / CPR (5 decks)

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