Emergency and Critical Care (1-3) Flashcards
this is when tissue perfusion & oxygen delivery is insufficient to meet metabolic demands of tissues
shock
this is inadequate blood flow to tissues
Tissue hypoperfusion
what 3 things can cause tissue hypoperfusion?
- not enough blood
- blood not being pumped efficiently
- blood not going to the right place
name the type of shock
due to loss of circulating volume;
caused by:
haemorrhage, vomiting/diarrhea, burns, third spacing
Hypovolaemic shock
name the type of shock
due to maldistribution of blood;
can be due to septic shock or anaphylaxis
distributive shock
name two clinical signs of septic shock
- injected mucus membranes
- hypotension
name the term
the invasion and multiplication of microorganisms such as bacteria, viruses, and parasites that are not normally present within the body
infection
name the term
serious condition in which the body responds improperly to an infection
sepsis
name the term
a life-threatening condition that happens when your blood pressure drops to a dangerously low level after an infection
septic shock
name the term
the presence of bacteria in the bloodstream.
bacteraemia
name the term
the clinical name for blood poisoning by bacteria
septicaemia
name the term
an emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body
hypovolaemic shock
name the term
an exaggerated defense response of the body to a noxious stressor (infection, trauma, surgery, acute inflammation, ischemia or reperfusion, or malignancy, to name a few) to localize and then eliminate the endogenous or exogenous source of the insult
Systemic Inflammatory Response Syndrome (SIRS)
name 4 conditions that may cause obstructive shock (a subtype of distributive shock)
- Thrombus (ATE)
- Gastric Dilation and Volvulus (GDV)
- Pneumothorax
- Pericardial Effusion
name the type of shock
failure of the heart to pump effectively
cardiogenic shock
name two possible causes of cardiogenic shock
- end stage cardiac disease
- arrhythmias
what is the most important compensatory mechanism activated during shock in response to decreased preload with the aim to maintain perfusion to core organs
sympathetic nervous system
what two sympathetic nervous system receptors are activated in response to shock
- ⍺-adrenergic receptors (blood vessels)
- β1-adrenergic receptors (myocardium)
name two other shock compensatory mechanisms that are activated more slowly than sympathetic nervous system
- RAAS
- Release of Vasopressin
name 3 effects of Angiotensin II
- vasoconstriction
- Na retention in proximal tubule
- stimulates aldosterone release
name 2 effects of vasopressin
- systemic vasoconstriction
- incr. water and Na reabsorption in distal tubule (incr. circulating volume)
name 3 quantitative measures of shock
- blood lactate
- blood pressure
- ECG
what is the main use of Point Of Care UltraSound (POCUS) for in determining if hypovolaemic shock is present?
(detect 4 things)
detection of:
1. peritoneal effusion
2. pleural effusion
3. pericardial effusion
4. (pneumothorax)
should you administer fluids if the shock is cardiogenic?
NO
what is the treatment for hypovolaemic shock?
fluid therapy
what is the treatment for cardiogenic shock?
treat heart failure +/- arrhythmia
(do NOT admin. fluids)
what is the goal of fluid therapy as a treatment for hypovolaemic shock?
improve tissue perfusion by incr. preload
what type of fluid is recommended for treating hypovolaemic shock?
isotonic crystalloid
what is the fluid therapy recommendation for dogs with hypovolaemic shock?
(amount and time)
10-20 mL/kg IV over 15-20 min
what is the fluid therapy recommendation for cats with hypovolaemic shock?
(amount and time)
5-10 mL/kg over 15-20 min
what should be assessed following correction of hypovolaemia?
hydration status
what is the difference between fluid loss in hypovolaemia vs. fluid loss in dehydration?
- Hypovolaemia is fluid loss from intravascular compartment
- Dehydration is fluid loss from interstitial and intracellular compartment
intravascular changes (associated with hypovolaemic shock) can be assessed by these 5 perfusion parameters
- mucus membrane color
- capillary refill time
- heart rate
- pulse quality
- temperature
interstitial changes (associated with dehydration) can be evaluated by monitoring these 4 things
- moistness of mucus membranes
- skin tent response
- eye position
- corneal position
what is the estimated percent dehydration?
not detectable
<5%
what is the estimated percent dehydration?
tacky mucus membranes
5-6%
what is the estimated percent dehydration?
decr. skin turgor
dry mucus membranes
6-8%
what is the estimated percent dehydration?
retracted globes within orbits
8-10%
what is the estimated percent dehydration?
persistent skin tent due to complete loss of skin elasticity;
dull corneas;
evidence of hypovolaemia
10-12%
what is the estimated percent dehydration?
hypovolaemic shock;
death
> 12%
what type of drug is required for septic shock?
Vasopressors
(noradrenaline)
what are the 5 most important emergency diagnostics
- Bloods
- SpO2
- ECG
- POCUS
- Blood Pressure
what is a normal SBP (systolic blood pressure) in an awake animal
100-140 mmHg
what should pulse oximetry ideally be
at least 96%
in animals breathing room air, small changes in SpO2 mean there will be big changes in this
PaO2
what 4 things should you check with an emergency blood panel?
- PCV and total solids
- lactate
- blood glucose
- blood smear
what should PCV for cats be
25-45%
what should PCV for dogs be
37-55%
what should total protein for a cat be
60-85 g/L
what should total protein for dogs be
55-70 g/L
what PCV and TP values would you expect for an animal with normal hydration or acute haemorrhage
normal
what PCV and TP values would you expect for an animal with dehydration, fluid shift
incr. PCV and incr. TP
what PCV and TP values would you expect for an animal with aggressive fluid therapy or haemorrhage (few hours after it started)
decr. PCV and decr. TP
what PCV and TP values would you expect for an animal with anaemia with dehydratiin OR hyperproteinaemia OR hyperglobulinaemia OR lipaemia
normal PCV and incr. TP
what PCV and TP values would you expect for an animal with protein loss (renal, from GIT) OR acute haemorrhage with splenic contraction OR decr. protein production in liver OR severe inflammation
normal PCV and decr. TP
what PCV and TP values would you expect for an animal with dehydration with hypoproteinaemia OR haemorrhagic diarrhea, splenic contraction OR polycythaemia
incr. PCV and normal TP
what PCV and TP values would you expect for an animal with haemorrhage with splenic contraction OR dehydration with protein loss (haemorrhagic diarrhea)
incr. PCV and decr. TP
what PCV and TP values would you expect for an animal with anaemia (due to RBC destruction OR decr. RBC production)
decr. PCR and normal TP
what shpuld blood glucose be for a cat
4-9 mmol/L
72-162 mg/dL
what should the blood glucose be for a dog
4-6 mmol/L
65-106 mg/dL
name 4 possible causes of low blood glucose
- young animals
- toy breed dogs
- sepsis
- neoplasia
name 3 possible causes of high blood glucose
- stress (cats)
- Diabetes mellitus
- pancreatitis
what should the lactate level be in cats and dogs
< 2.0 mmol/L
what is Hyperlactataemia most commonly due to?
insufficient O2 supply
what 3 things is a blood smear helpful in assessment of
- RBC (morphology)
- WBCs (morphology, differential count)
- PLTs (count, size)
how to take a manual platelet count estimate [x10^9/L]?
average number of platelets (from 10 fields) per high power field (x100) x 15
how many platelets should you normally see per high power field?
at least 10
if there is less than 3-4 platelets per high power field, what is there a risk of
spontaneous and uncontrolled bleeding
what are the 4 main goals of a thoracic point of care ultrasound (TPOCUS)
- rule out pleural effusion
- rule out pericardial effusion
- assess L atrial size
- assess lung parenchyma
where should you put the probe during TPOCUS for a look at the heart
on R hemithorax over the apex beat
(1-3 cm above sternum; 4th-5th intercostal space)
name 3 abnormal cardiac findings that can be found on a TPOCUS
- pericardial effusion
- LA enlargement
- systolic dysfunction
what 8 points should be assessed with a TPOCUS (lungs)
- Caudodorsal lung lobe region (CdLL) x2
- Perihilar lung lobe region (PhLL) x2
- Middle lung lobe region (MdLL) x2
- cranial lung lobe region (CrLL) x 2
what do B-lines/ultrasound lung rockets/ULRs/comets on a TPOCUS indicate?
wet lung
(presence of fluid in alveoli)
what do shred signs, tissue signs, or nodule signs on a TPOCUS indicate?
lung consolidation
what 5 points should be assessed in an abdominal POCUS
- Diaphragmaticohepatic view (DH)
- Splenorenal view (SR)
- Cystocolic view (CC)
- Hepatorenal view (HR)
- Umbilical (U) or gravity-dependent site
where to enter for a thoracocentesis for air?
1/3 dorsal thorax,
8th-9th intercostal space
where to enter for a thoracocentesis for fluid?
1/3 ventral thorax,
7th-8th intercostal space
name 5 signs that indicate when to transfuse
- tachycardia
- tachypnoea
- pallor
- hyperdynamic pulses
- lactate levels
how much tranfused whole blood increases PCV by 1%
2 mL/kg
how much transfused packed red blood cells increases PCV by 1%
1 mL/kg
how long can packed red blood cells be stored for
28 days in fridge
name the 4 labile factors present in fresh frozen plasma (FFP)
- V
- VIII
- vWF
- Fibrinogen
how long can fresh frozen plasma (FFP) be stored for before it becomes frozen plasma
1 year
what is missing from frozen plasma compared to fresh frozen plasma (FFP)?
labile factors;
clotting deficiencies (incl. vit K)
name the transfusion type
labile factors concentrated;
factors V, VIII, vWF, Fibrinogen
cryoprecipitate
name the transfusion type
rodenticide treatment;
oncotic support
crysupernatant (Cryopoor)
how long after first transfusion should cross matching between donor and recipient blood be tested?
greater than 4 days
(time it takes for antibodies to form)
how much plasma must be transfused for coagulopathies
10-20 mL/kg
what is the only fluid you should flush a transfusion IV line with
0.9% saline
what should the rate of a transfusion be?
0.25 mL/kg/h for 5 min;
double rate every 10 min
(but give all within 4h)
name the transfusion reaction type
type 2 hypersensitivity;
antibodies against cells;
w/in 24h of transfusion;
severe haemolysis;
DIC;
multiple organ dysfunction (MODS)
acute haemolytic transfusion reaction
name the transfusion reaction type
1-28 days post-transfusion;
antibodies made to donor cells;
destruction;
rapid reduction in PCV post-transfusion;
icterus
delayed haemolytic transfusion reaction
name the transfusion reaction type
incr. in rectal temp by >1°C;
within 4h of transfusion;
reaction to donor WBCs, platelets and transfused cytokines;
usually mild;
stop then slow the transfusion rate
febrile non-haemolytic reaction
name the transfusion reaction type
IgE mediated;
allergic reaction; pruritis, urticaria, vomit, oedema, GI;
anaphylaxis;
anti-histamines, adrenaline
acute hypersensitivity
what to look at on a point of care ultrasound to diagnose volume overload with a transfusion
left atrium:aorta ratio
