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ECC Flashcards

1
Q

What is shock?

A

Inadequate cellular energy production.

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2
Q

Outline the clinical signs consistent with shock.

A
  • Reduced mentation
  • Altered mucous membrane colour
  • Prolonged CRT
  • Cold extremities
  • Tachycardia
  • Weak/thready femoral pulse
    *
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3
Q

What is SIRS?

A

Systemic inflammatory response syndrome.

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4
Q

What is Sepisis?

A

SIRS with an infectious agent.

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5
Q

What is severe SIRS/sepsis?

A

Sepsis, associated with:
* Organ dysfunction
* Hypoperfusion
* Hypotension

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6
Q

What is MODS?

A

Multiple Organ Dysfuntion Syndrome.

Altered organ function in an acutely ill patient such that homeostasis can not be maintained without intervention.

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7
Q

What is refactory (septic) shock?

A

A subset of severe sepsis defined as: Sepsis induced hypotension despite adequate fulid resuscitation.

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8
Q

What are the types of shock?

7

A
  • Hypovolaemic
  • Cardiogenic
  • Distributive
  • Metabolic
  • Hypoxaemic
  • Cryptic
  • Combined
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9
Q

What is cardiogenic shock?

A

Decreased forward flow from the heart. Multiple causes including: CHF, drug overdose, tamponade (compression of heart by fluid in pericardial sack).

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10
Q

What is distributive shock?

A

Loss of systemic vacular resistance

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11
Q

What is metabolic shock?

A

Deranged cellular metabolic machinery.

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12
Q

What is cryptic shock?

A

Normal global circulation but poor microcirculation (capillaries)

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13
Q

What is the ‘shock organ’ in dogs?

A

The GI tract

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14
Q

Outline the clinical signs of an animal with a fluid deficit of < 5%.

A

No clinically detectable signs.

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15
Q

Outline the clinical signs of an animal with a fluid deficit of 5-7%.

6

A
  • Mild depression
  • Slightly prolonged CRT
  • Slight increase in heart rate
  • Increased blood lactate concentration
  • Creatinine levels increased
  • Concentrated urine
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16
Q

Outline the clinical signs of an animal with a fluid deficit of 10%.

8

A
  • Depressed
  • May have cold extremities
  • Dry mucous membranes
  • CRT >3 seconds
  • Heart rate 50% greter than normal
  • Increased blood lactate
  • Increased creatinine
  • Small volume of very concentrated urine
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17
Q

Outline the clinical signs of an animal with a fluid deficit of 12-15%.

8

A
  • Depressed
  • Cold extremities
  • Dry mucous membranes
  • CRT >4 seconds
  • Heart rate 100% greater than normal
  • Increased blood lactate concentrations
  • Increased creatinine
  • Unliekely to produce any urine
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18
Q

Outline hypotonic fluids.

1

A

5% dextrose

Glucose moved into cells, making it like sterile water

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19
Q

Outline isotonic fluids

3

A
  • Hartmanns (LRS)
  • 0.9% saline
  • 5% dextrose in 0.9% saline
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20
Q

Outline hypertonic fluids

2

A
  • Hypertonic saline (any above 0.9%)
  • Parentral nutrition.
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21
Q

What are the benefits of hypertonic saline?

5

A
  • Attractive if there is a limited period of time for resucscitation
  • Vasodilation
  • Increased cardiac contractility
  • Immuno-mudulatory effects
  • Benefit for intracranial hypertension
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22
Q

What are the drawbacks of hypertonic saline?

6

A
  • Hypernatraemia
  • May cause neurological signs if excessive amounts are used
  • Bradycardia (if adminsitered too fast)
  • Hypotnetsion (if adminsitered too fast)
  • Can’t use in dehydrated patients
  • Can’t be used in foals
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23
Q

When is hartmann’s (LRS) not appropriate?

3

A
  • Renal failure
  • Hypernatraemia
  • Hyponatraemia
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24
Q

What fluids are used per rectum and in what cases?

5

A

Water (tap)

  • Oesophageal tear
  • Tetanus
  • Gastric impaction
  • Cost
  • Where an IV can’t be obtained.
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25
Q

What are the indicators for a blood transfusion?

5

A
  • Anaemia
  • Coagulopathy
  • Thrombocytopenia
  • Thrombopathia
  • Hypoproteinaemia
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26
Q

What is the dog universal donor?

A

DEA 1.1 negative

27
Q

What is the universal equine donor?

A

AaQa negative

28
Q

What are the effects of protein catabolism?

Importance of nutrition (4)

A

It leads to:
* Impaired tissue synthesis
* Immunodeficiencies
* Reduction in GI integrity
* Affects drug metabolism

29
Q

How is RER calculated

A

70*BW^0.75

Or

30*BW + 70

30
Q

Outline the different forms of feeding tubes and which require surgical placement (SP)?

5

A
  • Syringe feeding
  • Naso-oesophageal/gastric tube
  • Oesophagostomy (SP)
  • Gastrostomy (SP)
  • Enterostomy (SP)
31
Q

Outline common problems with feeding tubes.

A
  • Blockages
  • Dislodging of the tube
  • Trauma
  • Infection
  • Over-granulation
32
Q

Outline the advantages of parenteral nutrition

4

A

When the entral route is not feasible:
* Nausea/vomiting
* Cannot protect the airway
* Animal too sick to eat
* To avoid collic

33
Q

Outline the disadvantages of parenteral nutrition

8

A
  • Requires 24 hour monitoring
  • Requires glucose monitoring
  • Vascular access needed
  • Expensive
  • Don’t provide complete nutrition
  • Requires electrolytes and trace-elements
  • Drug-nutrient interactions
  • Microbial contamination
34
Q

Outline the primary casues of TBI

2

A
  • Damage caused by trauma (kick to head, RTA)
  • Haemorrhage and oedema into sealed crainal space
35
Q

Outline possible secondary injuries

3

A
  • Excitatory neurotransmitters
  • Reactive oxygen species
  • Pro-inflammatory cytokines
36
Q

What can secondary injuries lead to?

4

A
  • Cerebral oedema
  • Increased intra-cranial pressure
  • Compromise to the blood-brain barrier (by cytokines)
  • Alertations in cerebrovascular reactivity.
37
Q

What systemic contributions can worsen secondary brain injury?

7

A
  • Hypotension
  • Hypoxia
  • Hypoglycaemia
  • Hyperglycaemia
  • Hypercapnia
  • Hypocapnia
  • Hyperthermia
38
Q

Outline diagnositc steps for TBI

A
  • Full neurological exam
  • Modified Glasgow coma scale used often
39
Q

Outline how the MGCS works

A

Higher scores correlate with a better prognosis.

40
Q

Outline the treatment principles for TBI

3

A
  • Correct tissue perfusion problems.
  • Decrease ICP by reducing oedema
  • Minimise increases in cerebral metabolic rate.
41
Q

Outline the basics of fluid therapy in cases with TBI.

A

Use fluid therapy to solve hypovoleamia.

7.2% hypertonic saline rapidly restores circulating volume. 4ml/kg over 3-5 mins.

42
Q

Outline the basics of CO2 monitoring with TBI.

A

Use blood gas analysis and pulse Ox to monitor PaCO2 levels.

Hypercapnia leads to vasodilation and the woresening of ICP.

Hypocapnia results in vasoconstriction and reduced intra-cerebral perfusion.

Aim for 40 mmHg

43
Q

Outline temperature control with TBIs.

A

Do not activly warm hypothermic patients.

Do actively cool hyperthermic patients.

44
Q

Outline the use of analgesia and anti-convulsant therapy.

A

Analgesia should be used. Opiods are likely to be effective.

Anti-convulsant therapy with phenolbarbitone is also beneficial. Especially in the first week.

45
Q

Should steroids be used?

A

No

46
Q

Outline the principles of motility modification when treating TBI.

A

Maintain motility using cisapride or ranitadine and metaclopramide.

Gut motility is vital in treating TBI.

47
Q

Outline the role of nutirition when treating TBIs.

A

Vital

Entrally feed if possible as this maintains integrity of GI mucosa.

However, if not possible (patient unconscious), parentral nutrition should be used. Monitor glucose levels and use insulin.

Pro-kinetics and maropitant may need to be used.

48
Q

Outline what parameters you would monitor in a patient with TBI.

3

A
  • MGCS - looking for improvements in 24-48hrs
  • Blood pressure (hypovolaemia)
  • Blood gas (hypoxia/Hype/ocapnia)
49
Q

What follow-ups can be done for patients with UTIs?

A

Advanced imagery

Urinary catheters

50
Q

Outline the advantages of CT scanning.

2

A
  • Higher sensitivity and specificity than ultrasound/radiography for detection of free fluid/gas and organomegaly.
  • Quick to obtain images once in the scanner
51
Q

Outline the disadvantages of CT scanning.

3

A
  • Images need to be interpreted by a radiologist.
  • Slow to pre the patient - GA needed.
  • Limited avaliability.
52
Q

Outline the advantages of MRI

2

A
  • Excellent for diagnosis of intracranial lesions and spinal lesions.
  • Excellent for equine distal limb lameness
53
Q

Outline the disadvantages of MRI

3

A
  • Slow both to take image and for interpretation
  • Very rare
  • GA required
54
Q

Outline the advantages of radiology

4

A
  • Good sensitivity and specificity for free gas.
  • Good for orthopeadic emergencies
  • Easy to perform
  • Can be used for a wide range of body systems
55
Q

Outline the disadvantages of radiology

2

A
  • GA required
  • Limited assesment of actual organs (apart from size/location)
56
Q

Outline the uses of endoscopy

A
  • Excellent for upper respiratory distress in horses.
  • Can be used for curative intervention (i.e. removal of foreign bodies)
  • Requires GA in SA
57
Q

Outline the advantages of ultrasound

6

A
  • No GA required
  • Can examine abdmonial organs
  • Can examine lung surface
  • Can be used for other soft tissue structures like tendons and ligaments.
  • Allows for interventions. For example, ultrasound guided biopsy etc
  • Non-invasive
58
Q

Outline the disadvantages of ultrasound.

A
  • Does not allow assesment of deep throacic structures
  • Can not asses airways
59
Q

Outline the uses of a FAST scan in equine practice.

A

Used to assess colic cases

60
Q

What are the locations used in a FLASH scan?

A
  1. Ventral abdomen
  2. Gastric
  3. Spleno-renal
  4. Left middle third of abdomen
  5. Duodenal
  6. Right middle third of abdomen
  7. Cranioventral thoracic

Fast localised Abdominal Sonography of Horses

61
Q

What are the key things looked at during a FAST scan?

A
  • Free fluid
  • Apperance of the small intestine (degree of dilation/turgidity and motility)
62
Q

Outline the five views involved in a T-FAST exam of the Dog.

A
  1. Chest tube site (each side) - the 7-9 intercostal spaces.
  2. Pericardial chest site (each side) - between the 5-6 intercostal space.
  3. Diaphragmatico-hepatic view.
63
Q

What does a T-FAST exam assess?

A

it id designed to rule in/out air/fluid in the pleural space and the presence of fluid in the pericardial space.

64
Q

Identify the sites for an A-FAST exam.

A
  1. Diaphragmatico-hepatic
  2. Cysto-colic
  3. Hepato-renal - right flank site
  4. Spleno-renal - left flank site

FCP (14 decks)

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