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%