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DVM3: ECP > Emergency medicine > Flashcards

Emergency medicine Flashcards

1
Q

What are the 3 main components of a rapid emergency assessment?

A

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

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2
Q

MBSA - CV parameters & how to measure each

A 
Pulse quality (femoral/metatarsal a.)
MM colour (gums, lips > vulva, prepuce, penis) 
CRT (gum above canine tooth)
HR (auscult/Ax equipment)
Cardiac auscultation
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3
Q

what do each of the following MM colours indicate? pink, pale/white, red/injected, blue, yellow, brown, cherry red

A 
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
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4
Q

Normal CRT & causes of rapid/slow CRT

A 
Normal = 1 - 1.75s
Rapid = pain, excitement, fever, SIRS, early hypovolaemic shock (compensated)
Slow = hypoperfusion (late uncompensated shock)
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5
Q

MBSA - respiratory parameters

A 
Resp rate (15-30 bpm) 
Effort (abdo/chest movement)
Pattern (normal/paradoxical)
Auscultation (9 areas)
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6
Q

MBSA - CNS parameters

A

Gait - recumbent, lame, ataxic, paresis/paralysis

Mentation - depressed/stuporous, excitable/dysphoric, unconscious

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7
Q

What tests can be done to assess the abdomen on MBSA? What organs are assessed?

A

Palpation

  • liver/spleen
  • kidneys
  • intestine (small + large)
  • urinary bladder
  • uterus
  • prostate (per rectal)
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8
Q

Elements of a MBSA

A 
CV tests
Respiratory tests
CNS
Abdomen
Body T (if stable)
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9
Q

What are the 3 types of fluid therapy, their goals, & rate of administration?

A

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)

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10
Q

What are the clinical signs of interstitial dehydration? What treatment?

A

Dry + pink MM
Skin tenting
Normal mentation (maybe quiet)
Normal HR, pulse, BP

Tx = rehydration therapy

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11
Q

What are the clinical signs of hypovolaemia? What treatment?

A 
Dull mentation
Pale MM
Tachycardia
Hypotension
Long CRT
Pulse changes - tall/narrow or short/narrow

Tx = ARFT

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12
Q

What are the clinical signs of overhydration?

A

Gelatinous interstitum
Chemosis
Clear nasal discharge

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13
Q

Clinical signs at <5%/5-6%/6-8%/8-10%/>10% dehydrated

A 
<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
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14
Q

Fluid deficit formula

A

Deficit (mL) = BW (kg) x % dehydration x 1000 mL

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15
Q

Blood volume in dogs + cats

A 
Dogs = 80 mL/kg
Cats = 60 mL/kg
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16
Q

What mechanisms does the body use to maintain tissue perfusion in response to fluid loss?

A

Thirst/increased water intake
ADH = water retention
RAAS = water/Na+ retention

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17
Q

Maintenance fluid rate

A

2-4 mL/kg/hr

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18
Q

Rehydration therapy - administration rate (formula)

A

Rate (mL/hr) = (deficit V + maintenance V + ongoing loss V) / time (hrs)

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19
Q

Risk factors for complications of fluid therapy

A 
Heart disease
Pulmonary disease
Hypoalbuminaemia/other vascular disease
Severe anaemia
Oligoanuric renal failure
Traumatic brain injury
Complex underlying diseases
Severe Na+ derangements
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20
Q

What is the risk of fluid therapy in a hypernatraemic patient?

A

As [Na+] in neurons = [Na+] in blood

  • TF neuron [Na+] = high
  • rapid correction of blood [Na+] –> fluid flux into neurons –> cerebral oedema
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21
Q

What is the risk of fluid therapy in a hyponatraemic patient?

A

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)
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22
Q

List some safety limits of fluid therapy (i.e. when to stop)

A

Pulmonary oedema (tachypnoea, resp effort, pulmonary crackles)
Overhydration = chemosis, gelatinous interstitium, serous nasal discharge
SQ oedema (hocks)
Ascites
Pleural effusion

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23
Q

What are the 2 major groups of shock? what subtypes w/in each group?

A

Circulatory shock

  • Hypovolaemic
  • Distributive
  • Cardiogenic
  • Obstructive

Non-circulatory

  • Hypoxic
  • Metabolic
24
Q

Define the 4 types of circulatory shock

A

Hypovolaemic shock = low blood V
Distributive shock = inappropriate vasodilation or vasoconstriction
Cardiogenic shock = heart failure
Obstructive shock = blockage to flow

25
Q

Define the 2 types of non-circulatory shock

A 
Hypoxic = insufficient O2 in blood 
Metabolic = deranged cellular metabolic machinery
26
Q

Examples of causes of circulatory shock

A 
Hypovolaemic = haemorrhage, effusions
Distributive = SIRS, sepsis
Obstructive = GDV, thromboembolism
Cardiogenic = cardiomyopathy
27
Q

What are the stages of hypovolaemic shock in dogs (& features)?

A

Compensated = MAP + CO maintained by tachycardia + vasoconstriction
- tall/narrow pulses, short CRT

Decompensated = failure of compensatory mechanisms
- severe tachycardia, arrhythmias, long/absent CRT, short/narrow pulse, hyperlactataemia

28
Q

Features of hypovolaemic shock in cats?

A

Less marked tachycardia dt baseline high HR in response to stress

29
Q

Stages of maldistributive shock in dogs & features

A

Hyperdynamic (early) = tachycardia, tall/narrow pulse, injected MM, short CRT, tachypnoea, normo-/hypertension

Hypodynamic (late) = severe tachycardia, long/absent CRT, arrhythmias, hyperlactataemia, cyanosis

30
Q

Signs of distributive shock in cats

A 
Variable HR
Pale or icteric MM
Absent CRT
Hypothermia
Severe mental depression
Weak/unpalpable femoral pulse
31
Q

Distributive shock organ in dogs & cats

A 
Dogs = GIT, liver
Cats = lungs
32
Q

Signs of cardiogenic shock

A 
Similar to hypovolaemia (short pulse, pale MM, long CRT, tachycardia) 
Heart murmur
Gallop rhythm (cats)
Pulse deficits
33
Q

Signs of obstructive shock

A

Dependent on cause:

  • GDV = abdo distension
  • Cardiac tamponade = muffled heart sounds
  • pneumothorax = dull lung sounds
34
Q

Causes of metabolic shock

A 
Hypoadrenocorticism (Addisons)
Hypoglycaemia
Hyperkalaemia 
Hypocalcaemia
Mitochondrial dysfcn
35
Q

Wht is the universal sign of metabolic shock?

A

mental depression

36
Q

Causes of hypoxic shock

A 
Anaemia (low Hb)
Pulmonary parenchymal disease (pneumonia)
Hypoventilation
Dyshaemoglobinaemias
CO poisoning
37
Q

Signs of hypoxic shock

A

Cyanosis (or pale/brown dep on causes)
Dyspnoea
Lung crackles

38
Q

What is the protocol for ARFT?

A

Assess shock
Fluid aliquot (over 5-15 min)
–> cycle until no shock

39
Q

What types of fluid can be used in ARFT? When should each be used

A

Isotonic crystalloids = hypovolaemia
Hypertonic saline = rapid V expansion, head trauma (dec ICP), large dogs
PRBC/FFP/whole blood = acute haemorrhage
Synthetic colloids = small V resuscitation

40
Q

CI’s for hypertonic saline in ARFT

A

dehydration
normo-/hypervolaemia
hypernatraemia
renal disease

41
Q

To what target PCV should PRBC/whole blood be given?

A

20%

42
Q

ARFT Resuscitation end point parameters

A 
Pink MM
CRT <2s
normal pulse
normal HR
T of extremities increasing
improved mentation
MAP >65-70 mmHg
Urine output >2 Ml/kg/hr
Lactate <1.5 mmol/L
PCV >20%
43
Q

ARFT Safety endpoint signs

A

Lung crackles
Increased RR/effort
CVP > 8 mmHg (dogs)
CVP > 5 mmHg (cats)

44
Q

What major body systems must be stabillised following intoxication & how?

A

Respiration - intubation, O2, PPV, bronchodilators
Circulation - catheter, fluids, vasopressors
CNS excitement - diaz/medaz, Ax

45
Q

What steps can be taken to prevent ongoing toxin absorption?

A 
Induce emesis - apomorphine, NaCO3, xylazine
Gastric lavage (2 tube method)
Enema (warm water)
Cathartics (sorbitol, parrifin)
Adsorbents (activated charcoal)
Lavage of topical intoxication
46
Q

Define septic shock

A

Profound circulatory, cellular & metabolic abnormalities dt sepsis

47
Q

What clinical parameters define septic shock?

A

Sepsis +

  • vasopressors required to get MAP >65 mmHg
  • Lactate >2.0 mmol/L
  • critical illness despite adquate fluid resusscitation
48
Q

What are the 3 major routes of pathogenesis involved in septic shock/SIRS?

A

Distributive shock dt imbalance of vasodilators/vasoconstrictors in response to inflammation

Tissue hypoperfusion dt dysregulated coagulation –> hypercoagulability, DIC, inappropriate vasoconstriction

Microcirculatory/metabolic dysfunction dt dec functional capillary density/uneven perfusion/mitochondrial dysfcn

49
Q

Diagnosis of septic shock/SIRS in dogs

A

Early hyperdynamic state = injected MM, fast CRT, tachycardia, tall/wide pulse, pyrexia, hypertension, tachypnoea

Late hypodynamic state = pale/icteric MM, slow CRT, tachy-/bradycardia, short pulse, hypotension, pyrexia/hypothermia, cool extremities, mental dullness

50
Q

Diagnosis of septic shock/SIRS in cats

A

No early hyperdynamic state

Late hypodynamic state = pale MM, bradycardia, weak pulse, hypothermia/normothermia, mental dullness, CRT hard to assess

51
Q

What laboratory parameters are indicative of septic shock/SIRS?

A 
Hyperlactataemia/metabolic acidosis
Variable BP (high in early, low in late)
PaCO2 varies by tissue
Hyperventilation/respiratory alkalosis
Hyperglycaemia --> hypoglycaemia
Hypoalbuminaemia
Hyperbilirubinaemia (intra-hepatic cholestasis of sepsis)
Hypercalcaemia (dysreg PTH
Pre-renal azotaemia (dec GFR)
High ALT
Variable neutrophils
L shift + toxic change
Monocytosis
Thrombocytopaenia
Prolonged PT/PTT/ACT/FDP
52
Q

What is the shock organ of septic shock/SIRS in cats & dogs?

A 
Dogs = resp tract + peritoneal space
Cats = peritoneal space + urogenital tract
53
Q

What are some common causes of septic shock/SIRS?

A 
GIT perforation/septic peritonitis
Pleural effusions
Pyometra
Endocarditis
Trauma
54
Q

What are the fundamental stages of management of sptic shock/SIRS?

A

Haemodynamic control = ARFT
Parenteral AB therapy if bacterial sepsis
Source control

55
Q

What measureable parameters & values can indicate shock?

A 
MAP < 80 mmHg
UOP < 1-2 mL/kg/hr
Lactate > 2.5 mmol/L
Arteriovenous CO2 gradient
Venous CO2 gradient
56
Q

What kinds of shock require fluid therapy? which don’t?

A

Yes: hypovolaemic, distributive, obstructive ± metabolic
No: cardiogenic
Sometimes: hypoxic

DVM3: ECP (5 decks)

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