Emergency medicine Flashcards
What are the 3 main components of a rapid emergency assessment?
ABCs - patent airway, useful breathing efforts, heart beat/pulse
Presenting complaint
Capsule history - age, breed, sex/neuter status, duration of issue, appetite/water intake, vax status, current medication
MBSA - CV parameters & how to measure each
Pulse quality (femoral/metatarsal a.) MM colour (gums, lips > vulva, prepuce, penis) CRT (gum above canine tooth) HR (auscult/Ax equipment) Cardiac auscultation
what do each of the following MM colours indicate? pink, pale/white, red/injected, blue, yellow, brown, cherry red
pink = normal Pale/white = anaemia, poor perfusion Red/injected = distributive shock (pain/SIRS) Blue = cyanosis (PaO2 = 20-40 mmHg) Yellow = icterus/bilirubinaemia Brown = paracetamol Cherry red = carbon monoxide
Normal CRT & causes of rapid/slow CRT
Normal = 1 - 1.75s Rapid = pain, excitement, fever, SIRS, early hypovolaemic shock (compensated) Slow = hypoperfusion (late uncompensated shock)
MBSA - respiratory parameters
Resp rate (15-30 bpm) Effort (abdo/chest movement) Pattern (normal/paradoxical) Auscultation (9 areas)
MBSA - CNS parameters
Gait - recumbent, lame, ataxic, paresis/paralysis
Mentation - depressed/stuporous, excitable/dysphoric, unconscious
What tests can be done to assess the abdomen on MBSA? What organs are assessed?
Palpation
- liver/spleen
- kidneys
- intestine (small + large)
- urinary bladder
- uterus
- prostate (per rectal)
Elements of a MBSA
CV tests Respiratory tests CNS Abdomen Body T (if stable)
What are the 3 types of fluid therapy, their goals, & rate of administration?
Acute resuscitative fluid therapy = correction of hypovolaemia/hypoperfusion (rapid)
Rehydration fluid therapy = correction of dehydration (6-24hrs)
Maintenance fluid thearpy = replacement of body fluids lost over a time period when intake is reduced (calculated rate)
What are the clinical signs of interstitial dehydration? What treatment?
Dry + pink MM
Skin tenting
Normal mentation (maybe quiet)
Normal HR, pulse, BP
Tx = rehydration therapy
What are the clinical signs of hypovolaemia? What treatment?
Dull mentation Pale MM Tachycardia Hypotension Long CRT Pulse changes - tall/narrow or short/narrow
Tx = ARFT
What are the clinical signs of overhydration?
Gelatinous interstitum
Chemosis
Clear nasal discharge
Clinical signs at <5%/5-6%/6-8%/8-10%/>10% dehydrated
<5% = undetectable 5-6% = dry MM 6-8% = dry MM + skin tenting 8-10% = dry MM + skin tent + sunken eyes >10% (hypoperfusion) = dull, tachycardia, long CRT, pale MM, poor pulse
Fluid deficit formula
Deficit (mL) = BW (kg) x % dehydration x 1000 mL
Blood volume in dogs + cats
Dogs = 80 mL/kg Cats = 60 mL/kg
What mechanisms does the body use to maintain tissue perfusion in response to fluid loss?
Thirst/increased water intake
ADH = water retention
RAAS = water/Na+ retention
Maintenance fluid rate
2-4 mL/kg/hr
Rehydration therapy - administration rate (formula)
Rate (mL/hr) = (deficit V + maintenance V + ongoing loss V) / time (hrs)
Risk factors for complications of fluid therapy
Heart disease Pulmonary disease Hypoalbuminaemia/other vascular disease Severe anaemia Oligoanuric renal failure Traumatic brain injury Complex underlying diseases Severe Na+ derangements
What is the risk of fluid therapy in a hypernatraemic patient?
As [Na+] in neurons = [Na+] in blood
- TF neuron [Na+] = high
- rapid correction of blood [Na+] –> fluid flux into neurons –> cerebral oedema
What is the risk of fluid therapy in a hyponatraemic patient?
As [Na+] in neurons = [Na+] in blood
- TF neuron [Na+] = low
- rapid correction of blood [Na+] –> fluid flux out of neurons –> osmotic demyelination syndrome (shrinkage)
List some safety limits of fluid therapy (i.e. when to stop)
Pulmonary oedema (tachypnoea, resp effort, pulmonary crackles)
Overhydration = chemosis, gelatinous interstitium, serous nasal discharge
SQ oedema (hocks)
Ascites
Pleural effusion