Emergency Stabilisation Flashcards
When is atropine appropriate to use?
Bradycardia
Evidence suggests routine use in CPR does not improve outcome
What is the only proven treatment for ventricular fibrillation?
Electrical defibrillation
What signs make it mroe suggestive that a cat’s dyspnoea is cardiac in origin?
A gallop sound, rectal temperature less than 37·5°C, heart rate of greater than 200 bpm and respiratory rate greater than 80 per minute
What are the levels of dehydration?
<5 per cent Not detectable
5-6 per cent Subtle loss of skin elasticity
6-10 per cent Definite delay in return of skin to normal position, Eyes possibly sunken in orbits, Possibly dry mucous membranes
10-12 per cent Tented skin stands in place, Eyes sunken in orbits, Dry mucous membranes
12-15 per cent As for 10-12 per cent, plus possible signs of shock (eg, tachycardia, cool extremities, rapid and weak pulses, prolonged capillary refill time
What do you need to monitor when giving hypotonic fluids
Electrolytes q12 as can dilute Na and K
What are the doses of dogs and cats for shock fluids
Dogs - Volume = 90ml/kg. Crystalloid 20-30 over 20 mins. Colloid 5-10ml/kg
Cats - volume 60ml/kg. Crystalloid 5-10ml, Colloid 2-5ml/kg
What are the types of shock?
Hypovolaemic
Distributive
Obstructive
Cardiogenic
Outline the RAAS response to shock
Low BP noticed in kidneys
Leads to production of angiotensin II
This leads to aldosterone - Na and H20 retention
And ADH release - vasoconstriction, H20 retention
How long do crystalloids last?
30-60 minutes
When is hypertonic saline useful?
Head trauma or large dogs
4-6ml/kg for dogs over 10 mins
3-4ml/kg cat
What are the risks of hypertonic saline?
Can cause high Na with repeated boluses
If given too fast, can cause bradycardia, hypotension, bronchoconstriction
Outline the use of colloids
Fluid containing particles greater than 30kDa that generate a oncotoic pressure
More expensive
Can cause AKI
Uncommonly can cause immunological reactions/ induced coagulopathy
Don’t really see an increase in oncotic pressure even when there is low albumin
When should you give FFP?
Coagulopathy
Clotting times >25% over rr AND clincal signs of bleeding
When do you need a cross match?
When already had a transfusion more than 4d ago
What blood types are cats?
Lots of DSH are type A
Lots of breeds are B
But not always!
How much blood do you need to give for an increase of 1% PCV?
1.5ml/kg
What should you do if there is a blood transfusion reaction?
Collapse/ tachycardia/ dyspnoea/ pyrexia more than 1.2degrees = STOP, spin donor blood and check for haemolysis, may need steroids/ antihistamines. If just pyrexia, give 15 min and if OK start but slower
>1 increase in pyrexia - slow down
How do you calculate cerebral perfusion?
MAP - ICP
What is the aim of replacement fluids?
Replace body water and electrolyte deficits
Electrolyte balance similar to ECF (sodium and K+ levels)
What are the features of Hartmann’s solution?
Replacement solution
less Na K Ca and Mg than plasma and is slightly hypotonic
Not suitable for patients where intracellular movement of fluid would be bad (cerebral oedema)
Includes lactate which acts as a bicarb precursor, therefore producing an alkalising effect, therefore ideal for patients with metabolic acidosis - e.g. V+ patients with intestinal losses, hypovolaemic animals, d+, renal dz, GDV, distributive shock
Has Ca in it so cannot pass through the same line aas blood products
Not ideal for hypercalcaemic patients due to
What are the features of physiological saline?
Slightly higher Na and much higher Cl than plasma
Good for hypercalcaemic patients as it promotes calciuresis by increasing renal Ca excretion while decreasing Ca reabsorption by direct competition with Na
What are the features of Ringer’s solution
Acidifying action similar to saline, but slightly lower levels Na, higher levels Cl, and additional K and Ca
What are the features of plasma lyte 148
Not really available in UK
Similar to Hartmann’s as a bicarb precursos but is isotonic not hypotonic
What are maintenance fluids?
For provision of water and small amounts of electrolytes, can’t be used as replacement as less Na and more K than plasma
Typical animal needed it would be comatosed
E.g. dextrose in water, dextrose in saline (when this has K+ added it can be useful for animals unable to take in water (e.g. cats with maxillary injuries), also can be used for salt intoxication
Outline 0.45% saline
Allows new solutions with varying acidity levels to be produced when trying to replace saline at a steady state
Outline hypertonic saline
Plasma volume expander
Can limit lung and cerebral fluid accumulation in various forms of shock and organ injury
Decreases reperfusion injury
Immunomodulatory effects
May be a +ve inotrope and cause systemic and pulmonary vasodilation
Can cause High Na and low K so these are contraindications
Can be used to Tx high ICP
What is the aim of colloid therapy?
Treat hypovolaemia and aim the maintenance of plasma volume
How are colloids described?
By molecular weight (an average)
Can be monodisperse or polydisperse
Solutions with small particles exert a greater oncotic effect therefore generating greater volume expansion, but with a less sustained action
Outline the usage of hydroxyethyl startch
Indications - hypovolaemic and septic shock, plasma volume expansion, hypoproteinamia/ low colloid osmotic pressure
Contraindications - Cardiogenic shock
Complications and risks - Coagulopathy/ volume overload
Monitor closely - Coag times, esp APTT, HR, pulse, BP RR and effort
Outline the usage of dextrans
Indications - hypovolaemic and septic shock, plasma volume expansion, hypoproteinamia/ low colloid osmotic pressure
Contraindications - Cardiogenic shock
Complications and risks - Coagulopathy/ volume overload, anaphylaxis
Monitor closely - Coag times, HR, pulse, BP RR and effort
Outline the use of gelatins
Indications - hypovolaemic and septic shock, plasma volume expansion, hypoproteinamia/ low colloid osmotic pressure
Contraindications - Cardiogenic shock
Complications and risks - volume overload, anaphylaxis
Monitor closely - HR, pulse, BP RR and effort
Outline the use hypertonic saline
Indications - hypovolaemic and septic shock, plasma volume expansion especially with concurrent head trauma, cerebral oedema
Contraindications - Cardiogenic shock, pulmonary contusions, dehydration, hypernatraemia
Complications and risks - volume overload
Monitor closely - HR, pulse, BP RR and effort, note - max effect 1hr
Outline the use of oxyglobin
Indications - hypovolaemic and septic shock, plasma volume expansion, provision of oxygen carrying capacity, anaemia
Contraindications - Cardiogenic shock/ CHF
Complications and risks - hypertension, volume overload, hypertension, interference with blood tests, discoloration of membranes and u+
Monitor closely - HR, pulse, BP RR and effort, Hb conc (PCV not a good indicator once given)
How do some colloids cause coagulopathies?
By decreasing factor VIII and vWF concentrations
only high molecular weight HES solutions
May cause thrombocytopaenia by interferring with plately surface ligand binding
What are dextrans
Polydisperse solutions of glucose polymers
Which colloid is most likely to cause anaphylaxis?
Gelatins
N.B gelatin persistence is poor - 2-3hrs
When is human albumin solution most commonly used?
Hypovolaemic, severely hypoalbuminaemic patients with serious ongoing losses
What does FFP contain therapeutic levels of?
Fibrinogen, VWF
factors II, V, VII, VIII, IX, X, XI
Also has albumin, acute phase proteins, immunoglobulins, antithrombin
When is FFP indicated?
Acquired coaguloapthy ( rodenticed, DIC, GI h+)
SIRS/ Sepsis
Surgical patients with multiple indications, including support for wound healing, coag factor repacement, provision of drug binding, pH buffering capacity, volume replacement
What is oxyglobin?
polymerised bovine haemoglobin solution that provides addiational o2 carrying capacity by increasing concentration of haemoglobin in plasma
Potent colloid and vasopressor
Lower affinity for 02 and RBCs, resulting in a more efficient release of 02 at tissue level
\less viscous than blood whihc facilitates tissue perfusion even when vasoconstriction exists
How is the total body water level broken down?
categorized into two main compartments: the intracellular space, which constitutes 67% of this fluid; and the extracellular space, which makes up the remaining 33%
The extracellular compartment is further divided into the interstitial space, which consists of 75% of the extracellular space; and the IV space, which represents the remaining 25%.
The IV space represents 8% of BW in the dog and 6.5% of BW in the cat
Why can diarrhoea cause low potassium?
Why is this important?
High potassium concentrations are found in fecal matter. Profound diarrhea can also result in hypokalemia. Furthermore, severe or chronic hypokalemia aggravates a patient’s morbidity by leading to carbohydrate intolerance, anorexia, exacerbation of lethargy, and gastrointestinal hypomotility.
What would be an appropriate fluid for a dehydrated animal with high Na?
If the serum sodium concentration is increased, the patient has hypertonic dehydration and needs more water than salt for replacement.
Examples of hypotonic fluids are 5% dextrose and 0.45% saline in 2.5% dextrose.
