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AAA VMS4001 > Equine Patient Assessment + Key Parameters > Flashcards

Equine Patient Assessment + Key Parameters Flashcards

1
Q

Adult temp

A

37.5 - 38.5 C

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2
Q

Foal temp

A

37.2 - 38.9

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3
Q

Total body water

A

62 - 67% BW

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4
Q

Hypovolaemia

A
  • Dec in CIRCULATING BLOOD VOL
  • Loss of circulating IV fluid (plasma vol)
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5
Q

Dehydration

A
  • Loss of INTERSTITIAL/IC (intracellular) fluid
  • No change in circulating vol
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6
Q

Hypovolaemia -> dehydration

A
  • E.g. H+ - blood loss from circulating blood/IV component -> draws additional fluid from interstitial fluid
  • Severe cases -> H+ cannot be stopped, will draw from intracellular fluid
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7
Q

Dehydration -> hypovolaemia

A
  • E.g. Sweat - fluid loss from interstitial component of ECF
  • If animal mildly dehydrated, can compensate + won’t draw upon other components if have access to water
  • Profuse sweating - will draw fluid from intracellular component to compensate
  • Severe cases - draw fluid from circulating blood vol
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8
Q

HR

A

32 - 46 bpm

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9
Q

Normal CVS parameters CE

A
  • HR = 32 - 46
  • Pulse quality (palp facial a.) = strong
  • Jugular refill = rapid
  • MM = pink
  • CRT = < 2 s
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10
Q

Mod endotoxaemic CVS CE

A
  • HR = > 60
  • Pulse quality = moderate
  • Jugular refill = slow
  • MM colour = dark pink -> red
  • CRT = 2 - 3 s
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11
Q

Severe endotoxaemia CVS CE

A
  • HR = > 100
  • Pulse quality = weak
  • Jugular refill = sluggish
  • MM colour = red -> purple
  • CRT = > 3 s
  • Sustained colour change = problem w/ peripheral perfusion
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12
Q

Normal moisture MM

A
  • Most
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13
Q

Dehydration of MM

A
  • Tacky/dry
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14
Q

Patient evaluation - dehydration

A
  • Tacky/dry mucous membranes
  • Prolonged skin tent - older horses may have due to dec elasticity
  • Sunken eyes (foals) - if in adults, then severe
  • (Tear film)
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15
Q

Patient evaluation - hypovolaemia

A
  • Tachycardia
  • Tachypnoea
  • Weak Peripheral pulse
  • Reduced Jugular refill
  • Altered Mentation - quiet, dull
  • Prolonged CRT - not refilled quickly
  • Cold Extremities
  • Decreased Urine output - lack of perfusion to kidneys
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16
Q

Packed cell vol (PCV)

A
  • Ref = 32 - 50%
  • Inc w/ splenic contraction, exercise, colitis (stress induced)
  • Dec w/ anaemia/whole blood loss
17
Q

Total solids/total serum protein (TSP)

A
  • Refractometer for TS
  • Normal, TP = 55 - 69 g/L
  • Inc w/ inflam - heavy parasite burden, hypovolaemia
  • Dec w/ hypoproteinaemia, colitis - GIT protein loss, PLE/PLN
18
Q

Blood lactate conc

A
  • Normal < 1 mmol/L
  • Lactate produced during anaerobic metabolism, sensitive indicator of altered tissue perfusion
  • Excessive inc w/ hypovolaemia - inc lactate production in tissues, reduced lactate clearance in liver + kidneys
  • Inc w/ sepsis or endotoxaemia
  • Persistent hyperlactaemia = poor PX
19
Q

Renal indices for poor tissue perfusion

A
  • Serum creatinine conc (80 - 177 µmol/L
  • Pre-renal azotaemia - associated w/ dehydration/hypovolaemia
  • Pre-renal azotaemia should respond to Tx but if not then IVFT to correct hypovolaemia/dehydration then renal dysfunc Tx
    Urine output/USG
  • Inc USG = early indicator of dehydration
  • Dec urine production/anuria = early indicator of hypovolaemia
20
Q

Arterial BP

A
  • Direct/indirect estimate of perfusion
21
Q

Arterial blood gas

A
  • Assessment of arterial oxygenation
  • Identify any acid-base imbalances
  • In states of hypovolaemia, metabolic acidosis will
    inevitably be present - should be corrected w/ IVFT
22
Q

Central venous pressure (CVP)

A
  • Indirect estimate of blood vol
23
Q

Fluid therapy

A
  • Treat hypovolaemia and dehydration
  • Prevent hypovolaemia + dehydration in horses that are unable to drink or to
    absorb fluids from the GIT
  • Treat specific electrolyte or acid-base abnormalities
24
Q

Hypovolaemia lab parameters

A
  • HR > 60 bpm
  • CRT > 2 s
  • PCV/TP > 70%/g/L
  • Lactate > 2.5 mmol/L
  • Creatinine > 177 µmol/L
25
Q

Hypovolaemia - fluid admin route

A
  • IVFT only option
26
Q

Dehydration - fluid admin route

A
  • 1). Oral (free choice)
  • 2). Enteral (intragastric) - nasogastric tubing, intermittent, place tube at reg intervals/in-dwelling nasogastric tube attached to head collar + sutured for CRI
  • 3). IV - most severely dehydrated/hypovolaemic
27
Q

Enteral FT

A
  • Correcting dehydration without need for voluntary intake
  • Still requires normal GIT function
  • Nasogastric intubation
    Intermittent - 6 - 8 L every 40-60 mins bolus, can cause abdominal pain Indwelling
  • CRI - Max 20 mL/kg/hr (10L/hr)
  • Add electrolytes to make isotonic 4.9g/L Salt and 4.9g/L Lo-Salt
  • Ideal for hydration of the GIT contents
  • Management of impactions of the large intestine
28
Q

IVFT

A
  • Ideal for systemically ill horses & foals
  • Only route recommended for; treatment of moderate to severe hypovolaemia; patients with GIT dysfunction (reflux/ileus post-Sx - guarantee fluid received directly into vascular system)
  • IV catheter sites - jugular v; cephalic v - foal; lateral thoracic v if jugular not available
29
Q

Crystalloid fluids

A
  • Go-to
  • Replacement solutions = isotonic, Hartmann’s/Lactated Rigner’s (closest to equine plasma), given large vols (40 - 50L, 5 L bags), rapid replacement of IV vol, only 25 - 30% of total vol will remain within circulation 30 min after admin
  • Hypertonic solutions - smaller vols to rapidly encourage drawing of fluid into circulating blood vol, rapidly reverse hypovolaemia but rapid follow-up w/ isotonic to prevent dehydration e.g. 7.2% NaCl - max dos 4 mL/kg (2 L) IV bolus, acts within 30 min
  • Hypotonic solutions - rarely used
30
Q

Colloid fluids

A
  • Biologic - whole blood, plasma, albumin
  • Synthetic - hyroxyethylstarch, gelatins, dextrans
  • Rarely used, expensive, AEs, allergic reactions/anaphylactic shock, less readily available
  • Indicated in rapid restoration of IV col + crystalloid fluids
  • Smaller vols + shorter infusions required for resuscitation
  • Don’t replace free water so not used alone
31
Q

Replacement fluid rates - IV fluid bolus

A

= Shock dose - rapid correction of hypovolaemia, normalisation of physical perfusion parameters + inc urination
- 60 - 80 mL/kg
- Give all 1/2 replacement vol rapidly (20 L)
- 40 L bolus takes approx 2 - 3 h via gravity infusion
- +/- hypertonic saline - 4 mL/kg bolus
- Colloid fluids - 10 mL/kg/d - give 3 - 5 mL/kg hetastarch as slow bolus, admin remainder of dose over following in 24 h

32
Q

Replacement fluid rates - ‘fluid challenge’

A
  • 10 - 20 mL/kg rapid IV bolus
  • Foals (risk of over-hydrating) = 0.5 - 1L as bolus then reassess perfusion
  • Repeat until signs of hypoperfusion resolve (3 - 4 times)
33
Q

Maintenance fluid rates

A
  • When already corrected deficit w/ replacement to maintain fluid content
  • When not eating/drinking as well - maintains hydration status
  • Adult = 2 - 3 mL/kg/h (50 - 70 mL/kg/d
  • Neonatal foals - 4 - 6 mL/kg/h (8I 0 - 140 mL/kg/d (neonates have higher body water content)
    • Ongoing losses - D+. gastric reflux, 3rd space loss, sweating
  • Discontinuation - look at perfusion parameters then gradual taper to < maintenance for 12 - 24 h before stopping
34
Q

Complications of FT

A
  • Thrombophlebitis
  • Electrolyte / acid-base derangements
  • Over-hydration (rare) - in foals

AAA VMS4001 (15 decks)

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