Emergency Medicine

Question 1

What are the three reasons for an animal to go into shock?

Answer 1

Failure of circulatory system to deliver blood to tissues
Failure of blood to carry enough oxygen
Failure of tissues to utilise oxygen (rare)

Question 2

What can circulatory shock be further divided into?

Answer 2

Hypovolaemic - Maldistributive - Cardiogenic - Obstructive

Question 3

What happens during hypovolaemic shock?

Answer 3

Lack of circulating volume - Tissue hypoperfusion - Commonest form - Due to haemorrhage

Question 4

What happens during maldistributive shock?

Answer 4

Inappropriate vasodilation - Global release of inflammatory mediators - Hypoperfusion

Question 5

What happens during cardiogenic shock?

Answer 5

Failure of heart as a pump - Secondary to cardiac diseases

Question 6

What happens during obstructive shock?

Answer 6

Obstruction to blood flow - Secondary to pericardial effusion/massive pulmonary thromboembolism

Question 7

How do you determine a patient is in shock?

Answer 7

Physical exam

Question 8

During hypovolaemia, which fluid compartment is fluid lost from?

Answer 8

Intravascular

Question 9

During dehyrdration, which fluid body compartment is fluid lost from?

Answer 9

All 3 - Intracellular, interstitial and intravascular

Question 10

What do you treat an animal which is dehydrated?

Answer 10

Crystalloid fluid slowly over 24 hour period

Question 11

What clinical signs would you see in a dog in severe hypovolaemic shock?

Answer 11

170-220 bpm - Gray, white or muddy MM - Prolonged capillary refill - Decreased pulse amplitude and width - Absent metatarsal pulse

Question 12

What is the hallmark of maldistributive shock?

Answer 12

Inappropriately red mucous membranes

Question 13

What other signs are normally seen with a dog with cardiogenic shock? Why?

Answer 13

Respiratory signs - Due to congestive heart failure

Question 14

Westie with markedly increase heart rate (160), poor pulses, pale mucous membranes, is subsequently identified to have a haemorrhagic abdominial effusion (haemoabdomen) and a PCV of 17% (normal being 37-55%) and total plasma protein of 35 g/L (reference range 54-70 g/L). The dog weighs 11 kg. What should be the next step for stabilising this patient?

Answer 14

Place an IV catheter in a peripheral vein (short, large bore catheter) and a bolus of fluid at 30 mL/kg over 20 minutes

Question 15

A dog presents to you in a collapsed state. Examination of the cardiovascular system reveals a heart rate of 260 bpm with poor peripheral pulses and pale mucous membranes with a CRT of 2s. The dog is tachypnoeic and has crackles on thoracic auscultation. What is the most likely cause of shock in this dog?

Answer 15

Cardiogenic

Question 16

As you identified the patient as in cardiogenic shock, what would be the main focus for stabilising this patient? Which of the following interventions for stabilisation would take priority?

Answer 16

Provide oxygen, administer a diuretic (to relieve pulmonary oedema), obtain and ECG and consider therapies aimed at slowing the heart rate down

Question 17

A 4y FN domestic short haired cat present to you with a 2 week history of weight loss. She has been noted to have a decreased appetite over the last couple of days. On major body system examination the following is assessed. Quiet, not interested in her surroundings, heart rate is 140/min with bounding femoral pulses, pale mucous membranes with capillary refill time of 1 second. Her respiratory rate is 60/min, she has marked respiratory effort and intermittently exhibits over mouth breathing. Her lung sounds are dull ventrally and bilaterally. She is neurologically depressed. Abdominal palpation reveal hepatomegaly
What are the 4 most important findings that require intervention

Answer 17

Dyspnoea, dull lung sounds ventrally, bounding femoral pulses, inappropriate heart rate - Remember it’s always “Heart, Brain and Lungs”

Question 18

A 4y FN domestic short haired cat present to you with a 2 week history of weight loss. She has been noted to have a decreased appetite over the last couple of days. On major body system examination the following is assessed. Quiet, not interested in her surroundings, heart rate is 140/min with bounding femoral pulses, pale mucous membranes with capillary refill time of 1 second. Her respiratory rate is 60/min, she has marked respiratory effort and intermittently exhibits over mouth breathing. Her lung sounds are dull ventrally and bilaterally. She is neurologically depressed. Abdominal palpation reveal hepatomegaly. What is the next step to stabilise the patient? Why?

Answer 18

Thoracocentesis - This cat is exhibiting significant dyspnoea. The presence of dull lung sounds ventrally is associated with pleural space disease.

Question 19

A 1 year old MN crossbreed dog presents after a road traffic accident. Major body examination reveals a heart rate of 180bpm with weak femoral pulses and pale mucous membranes with a prolonged capillary refill time. His respiratory rate is 40 bpm with normal effort. Auscultation reveals normal lung sounds bilaterally. He is neurologically obtunded.
Which of the following is the most appropriate assessment of the patient?

Answer 19

Severe hypovolaemic shock

Question 20

A 7 year old male entire Labrador presents collapsed. Major body system assessment reveals a heart rate of 160 bpm with bounding femoral pulses. His mucous membranes are congested (injected) with a capillary refill time of 2 seconds. Respiratory assessment reveals a rate of 40 bpm with harsh lung sounds bilaterally. He is obtunded.
What type of shock does he have?

Answer 20

Maldistributive shock

Question 21

In the following case localise the site of respiratory disease.
A 8 year old Labrador presents with signs of inspiratory dyspnoea. Examination reveals marked inspiratory effort and stridor, his lung sounds are harsh bilaterally with a large amount of referred noise. He is hyperthermic (40 deg C).

Answer 21

Upper airways

Question 22

A 8 year old Labrador presents with signs of inspiratory dyspnoea. Examination reveals marked inspiratory effort and stridor, his lung sounds are harsh bilaterally with a large amount of referred noise. He is hyperthermic (40 deg C). What is the next step in treating this patient?

Answer 22

Administer oxygen, administer a sedative, and decrease upper airway inflammation with a fast-acting corticosteroid

Question 23

What does treatment of hypovolaemic shock revolve around?

Answer 23

Replacing intravascular volume

Question 24

What is the first port of call when treating hypovolaemic shock?

Answer 24

Isotonic replacement crystalloid fluids (eg Hartmanns, lactated Ringers)

Question 25

What does the term ‘bolus’ refer to?

Answer 25

Volume of fluid administered relatively rapidly via the IV route

Question 26

When treating hypovolaemia, what are the suggested doses for cats and dogs when administering crystalloid fluids?

Answer 26

60-90mL/kg for dogs

40-60mL/kg for cats

Question 27

What is not normally used in cats for treating hypovolaemia but given at 4-7mL/kg for 20mins for dogs?

Answer 27

Hypertonic crystalloids

Question 28

What should be done to treat animals with maldistributive shock?

Answer 28

Underlying cause of inflammatory stimulus sought out - Fluid therapy also important - Sometimes need inotropes or vasopressors

Question 29

Where is fluid therapy generally contraindicated in shock patients?

Answer 29

Cardiogenic shock

Question 30

A patient comes in in shock, you find it to have pericardial effusion. What kind of shock is it in? How would this be treated?

Answer 30

Obstructive shock - Percardiocentesis

Question 31

How can you minimise the resistance of fluid flow into a patient?

Answer 31

Reduce the length of the catheter and choose the widest bore to increase radius of vessel