Emergency Critical Care Flashcards

1
Q

first step in an emergency

A

triage exam- ABC
A-Assess airways
B-Breathing?, Circulation

if no issues with htese check also DE
D- disability: seizure? ambulatory? demenour
E- skin bone or musce damaged??? evalutate uriary system. palpate bladder in every cat

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2
Q

Paradoxical breathing

A

when the chest expands during inhalation and the abdomen is drawn inwards and then during exhalation the abdomen is pushed outwards. as opo

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3
Q

Stertor

A

‘Stertor’ is noisy breathing which occurs above the larynx.

more like a snore
wetter sound

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4
Q

Stridor

A

noisy breathing that occurs at the level of the larynx or below.

an abnormal, high-pitched respiratory sound produced by irregular airflow in a narrowed airway
dryer sound

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5
Q

honking cough

A

issue in the trachea

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6
Q

wheezes auscultated in stethoscope

A

expiritory issue

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7
Q

crackles auscultated in stethoscope

A

lung parenchima issue

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8
Q

emergency treatment for respiritory distress

A
  • Oxygenate-
    □ Oxygen tent- allows control of FiO2, control of temp, control of humidity, co2 removal
    □ Mask/ flow by- can be given while doing procedure, needs to be close to patient to be effective, Small increase of Fio2
    □ Intubation- can achieve Fi02 100%, protection of airways, invasive
          - Localized in lower airway?- bronchodilator, contraindicated in pneumonia
          - Sedation
          - Gain IV access
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9
Q

sedation for respiritory distress

A

butorphanol- mu antagonist, kappa agonist. good sedation, little to no analgesia. good choice for everything EXCEPT anything needing analgesia. has antitussive properties. blocks the opertunity to give other opiods- 4 hours

alpha 2s cause peripheral constriction and then reflexive vasodilation and bradychardia. reverasble and short acting. much better pain managment but not benign on cardiovascular system. do not give to decrease heartrate

benzodiazapines- good fir unknown cardiovascular status, short acting and benign on those systems. can cause exitability

ACP- good sedative, no analgesia, NOT benign on cardiovascular system- vasodilation and not reveribe, takes longer to act. prolonged sedation- 4-6-8 hours. good for a prolonged recovery- heat stroke, BOAS, larygngeal paralysis ect

alfaxan and propofol usually interchangable however for longer term use alfaxan safer for cats (heinz body anemia)- alfaxan can be given IM

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10
Q

emergency diagnostics for respiritory distress

A

T-POCUS
NT-proBNP
C-POCUS

chest x rays should be done later when the appropriate tim ecan be taken

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11
Q

t- pocus

A

normal- should see rib, rib shadow, pleural line, subcutanious muc=scle and fat
a- lines: horizontal lines caused by reverberation from the air in the plural line- you cannot see the lung on ultrasound but you can only see a-lines with healthy lung

abnormal-
B lines- vertical lines caused by fluid accumulation in interstissial space- blood, oedema, inflamation (cannot tell what the fluid is but put it into context of case- RTA= BLOOD ECT)

When seen cranioventrally- Aspiration

when seen- perihelially (base of heart)- cardiogenic pulmonary oedema

hypoechoic line- fluid- can see conotour of lung. beam has not encountered air

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12
Q

NT- proBNP

A

a hormone released when their is atrial streach- the atrium is streached

if abnomal problem could be cardiact however can be abnomal in absense of heart disease
more diagnostic when it is normal as it its ore sensitive than specific

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13
Q

thoracosentesis

A

first step to treating pulmonary oedema caused by heart failure

interconstal space 7- position needle ventral and crainially
go on cranial aspect of rib to avoid vesels

use three way tap- needle in front, syringe and back, siscade line

butterfly needle

if blood is drained run pcv solid- pcv is low in effusion, so you know you are in pleural space and not vessel or heart. blood not from pleural space will clot and so needle should be retracted

once much of the fluid is drained the lung may brush up against the needle, o needle can be directed downwards to collect fluid

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14
Q

transudate

A

fluids that pass through a membrane or squeeze through tissue or into the EXTRACELLULAR SPACE of TISSUES. Transudates are thin and watery and contain few cells or PROTEINS.

indicated issue with hydrostatc or oncocotic pressue

congestive heart failure= high hydrostatic pressure

liver falure= low osmitoc pressure = transudate or modified transudate

<2.5 total protien (modified transudate >2.5 but less than 5 nucleated cells)
<1.5 nucleated cella

macrophages, neutorphils , lymphocytes and mesothelial cells present

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15
Q

exudate

A

s fluid that leaks out of blood vessels into nearby tissues. The fluid is made of cells, proteins, and solid materials. Exudate may ooze from cuts or from areas of infection or inflammation.

infection or inflamation causes vesseles to become “ leakier”- resulting in exudate

> 2.5 protien, often >4
greater than 5 nucleated cells

predominantly neutrophils on cytology

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16
Q

chylous effusion

A

looks like strawberry milkshake

17
Q

fluid analysis

A

the presence of chyle in the pleural space and usually result from disruption or obstruction of the thoracic duct.

can do biochem on fluids
can look at glucose (low glucose in infection as it is being consumed)
high lactare indicates infection
pottaium and creataine ratio- compare with blood. higher in effusion can indicate uero abdomen

billirubin can indicate peritonitis

18
Q

furosomide

A

Furosemide is a loop diuretic medication used to treat edema due to heart failure, liver scarring, or kidney disease.

second stage of treatment for cardiac disease
can be given im if iv acess cannot be established

19
Q

pimobendan

A

a heart medication used to treat dogs with congestive heart failure (CHF), usually caused by either dilated cardiomyopathy or valvular insufficiency. Its use in cats to treat heart failure is ‘off label’ or ‘extra label’

increases contactility- positive ionotrope

makes heart work smarter not harder

better in dogs in dilated carsiomyopathy but in cats not as effective at the ventrical is already woring and the problem is diastolic- the blood cannot travel properly due to the shape of the heart

20
Q

clopidorel

A

an antiplatelet medicine. It prevents platelets (a type of blood cell) from sticking together and forming a dangerous blood clot.

helps prevetn clots due to the turbulent flow of blood in cat heart falure- hypertorphic cardiomyopathy

21
Q

monitoring in cardiac cases

A

createnine and electroliytess- 24-48 hours- how are the kidneys doing on diaretics, will increase pre-renally but still good to monitor for AKI
monitor sodium and chlorisde, check if pottasium needs suplimented

hypradion status- q12hrs

reaspiritory rate and effort-q1-2hr

22
Q

diagnostics for a blocked cat

A

Minimum database- check for high K, urea, createnine
latate- marker of perfusion but also up with stress

ECG- looking for absent p waves and HIgh T (greater than 1/3 of QRS indicating atrial standtill- this is a consiqiuense of high potassium

contrast study

urinalysis

23
Q

managment for a hypercalemic blocked cat

A

resolve primary problem- when safe- cystocentesis, sacrococcygeal block, catheter

ivft- encorages excretion to excrete clcium

10% calcium gluconate
- allows action potentail to be reastablished and puts threshold higher so protects the heart form unwanted depolarisation

insulin and dextrose- drives pottasium into cells but mantains blood sugar- dextrose alone can also spike insulin which can be helpfull but giving insulin is quicker. with insulin dextrose must be given as CRI

sodium bicarbonate- rarley used. promotes metabolic alkalosis rebalences acid base levels to bring pottasium inside cells

terbutaline- bronchodilator, rarely used. beta 2 agonist. promotes potaissium shift inside cell

urinalysis can indicate need for antibiotics- ISCAID study guidence

24
Q

cystocentesis

A

can be performed consous
aseptic prep
lateral reumbancy or standing
use ultrasound guidence
place needle at the level of pelvic brim and advance caudally
use right side fo abdomen if standing

25
Q

post managment for blocked cat

A

fluid balance?- post obstructive diurisis requires constant assesment- fluids until cat can compensate, withdraw treatment when able
electrolyte monitoring
pain managment
catheter managment
when to discharge
medication

26
Q

shock

A

you do not have enough blood circulating around your body.
a lack of xygen delivery or uptake from cells
systemic vascular resistance
cardica output- preload, after load, contractility, rate
arterial xygen content

factors determining oxygen delivery-
how fast/ how much blood is there
how fast can it get there?

obstructive shock
hypovolemic shock
cardiogenic shock
distributive shock (septic)

27
Q

managment of hypovolemic shock

A

oxygen
fluid therapy
warm slowly

tanexamic acid- a medication used to treat or prevent excessive blood loss- 15mg/kg iv. bolus doese every 6 hrs

maropitant- 1mg/kg iv

co-amoxiclav 20mg/kg

pain relief can be considered once stable

28
Q

ascular volume status

A

assesed by perfusion parameters

hyovolemia
euvloeamia
hypervolemia

29
Q

hydration status

A

= intersitial tissue assesment

dehydrated
overhydrated

30
Q

fluid therapy hypertonic saline

A

hyper tonic saline draws fluids into the iv and so rehydrated quicker but nees to be imediatly with hartmans to replace the fluid from the interstitial space

best method to achive adiquate circulating volume quickly as ess fluids are needed

good for situations where the dog may be activly bleeding as less fluids meen less disruption and less dilution of nay clots forming

not 100% neccesary but usefull to know if available

3-5mls over 10 mins- not faster as salt will irritate the heart

31
Q

fluid therapy- crystaliods for hypovolemic shock

A

lactated ringers (hearman)best and commonly avilable

0.9% NaCl too much pottassium
plasmalyte not commonly availale but good if magenesium needed

isotonic- roughly the same composition as plasma

10-20ml/kg in boluses over 10-15 mins- consider patient size

fluid pumps cant go faster than a liter per hr- two pumps? pressure infuser? manual pressure?

reasees perfusion perameters between and stop boluses once fine

total shock doses (maximum to give)-
dogs- 80-90/kg per kg
cats- 40-60ml/ kg

then go to hight rate (10ml/kg for an hour

then go at maintinance

32
Q

coloids

A

fluids with salts and large molecules

mostly albumin

provided oncotic pressure

used when theres poor oncotic pressure- liver disease ect

natural-
whole blood
fresh frozen plasma
frozen plasma
albumin solution

synthetic- often not used due to aki risk (in long term use in humans)
tetrastarch
pentastarch
hetastarch gelatins

33
Q

blood products for hypovolemic shock

A

whole blood
placked rbc
frozen/fresh plaams
platlets

whole blood best but not readily avialable or easy to store

can replace clotting factors with plasma but frozen plasma doesnt have 3,5 and 8
fresh frozen plasma does

frozen plasma has albumin and is a good option- use water bath to defrost

supports vascular lining
provides clotting factord

shock dose (in bolus)- 5-10ml per kg

dogs- blood type if 2nd transfusionm
cats- ALWAYS BLOOD TYPE

autotransfusion??-
will start to dilute
missing platlets
risk of sepsis

drawn out of body cavity with three way tap

34
Q

diagnostics for hypovolemic shock

A

ecg- ventricular premature complexes triggered by low output and oxygen

blood pressure- high? due to trying to maintain pressure= compensated shock
ususlly hypotensive in distributive shock

point of care ultrasound- locate and chack for fluid

pcv- low- normal 40, tp= 50-60

35
Q

pcv and tp

A

normal 40 and 50-60

both increased= dehydration

decreased and increased Polycythemia vera
breed variation

normal and increased hyper globulinemia, artifactual

normal and decreased- liver not making enough, loosing protien. early bleed

decreased and normal- IMHA ect

decreased and decreased- blood loss
anemia + hypoprotinemia

36
Q

lactate in hypovolemic shock

A

marker of shoc and perfusion
product of anabolic respiration
can be a prognostic indicator

37
Q

how to monitor improvment in hypovolemic shock

A

monitor vitals
monitor perfusion
monitor mentation

repeat POCUS
repeat bloods- be aware giving colloids can reduce calcium in bloods due to the anti coagulants

repeat pcv and tp- ongoing bleeding ?

do clotting factor testing

38
Q
A