Diagnosis / monitoring Flashcards
What is the normal fractional shortening in dogs and cats
Dogs: 28-45%
Cats: 30-50%
<20% -> suggestive of severe systolic failure
What are the 5 sites of the abdominal POCUS and what organs do they show
- 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
What is the normal frequency of gastric or duodenal peristaltic contractions observed on POCUS in a non-fasted dog
4-5 contractions per minute
List 4 causes of loss of lung sliding on POCUS
- Non-ventilated lung (one-lung intubation)
- Pleural space disease (pneumothorax, pleural effusion, diaphragmatic hernia)
- Severe lung consolidation
- Pleural adhesion
- Severe lung hyperinflation
How to calculate urine volume based on bladder measurement
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
Name 3 characteristics that are always present with B-lines
What can B-lines be confused with?
- 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
Name the cardiac POCUS views
- Long axis right parasternal four-chamber view
- Right parasternal short axis transventricular view
- Right parasternal short axis transaortic view
- Subxiphoid view
What are the asynchronous and the double curtain signs?
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
What is a lung point?
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.
What are 2 diagnostic criteria for alveolar interstitial syndrome?
- Presence of >3 B-lines
- Coalescing B-lines
What 2 criteria are required for the presence of a Gide sign and name 5 causes of absence glide sign.
- The patient must take a breath
- The pleural sheets must be in contact
- Pneumothorax
- Pleural masses
- Effusion
- Apnea
- Adhesions
True or false: air bronchograms are present on POCUS assessment of PTE
False - usually absent with nodule sign and PTE
What is the normal CVC collapsibility index in a spontaneously breathing patient
25-50%
Fill in the blank: A feline left atrium bigger than ____ mm at the end of ventricular systole is considered enlarged.
16.5mm
What are the determinants of SvO2
- CO
- Hb concentration
- SaO2
- VO2 (oxygen consumption)
What rectal-interdigital temperature gradient is highly suspicious for shock in dogs
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
What is the shock index? What value is suggestive of shock in dogs and cats?
SI = HR/SBP
Dogs: SI>1.0 suggestive of shock, cats: SI>1.6
What point-of-care analysis of abdominal effusion would be suggestive of:
- septic peritonitis
- uroperitoneum
- bile peritonitis
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
What is Kirby’s rule of 20
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
Name 2 scores that can be used for prediction of mortality in patients presented after trauma
- ATT (Animal Trauma Triage) score
- mGCS (modified Glasgow Coma Scale)
What categories of parameters does the ATT score assess
Perfusion, cardiac, respiratory, eye/integument/muscle, skeletal, neurological
(Each graded 0-3, most severe being 3)
What are the parameters assessed in the canine APPLEfull (10) and APPLEfast (5) scores
APPLEfull: creatinine, bilirubin, age, SpO2, mentation score, fluid score, albumin, lactate, WBC, RR
APPLEfast: glucose, albumin, lactate, platelet, mentation score
What are the parameters assessed in the feline APPLEfull (8) and APPLEfast (5) scores
APPLEfull: mentation score, T, MAP, lactate, PCV, urea, chloride, fluid score
APPLEfast: mentation score, T, MPA, lactate, PCV
What are the normal values for lactate in dogs and cats
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)
