Everything Else Flashcards
What causes hypoalbuminemia?
Liver failure
Protein-losing enteropathy or nephropathy
Malnutrition
Systemic inflammation
What are the consequences for hypoalbuminemia?
Altered pharmacokinetics
Delayed wound healing
Decreased oncotic pressure
What causes hyperalbuminemia?
Dehydration
How is vascular resistance related to vessel diameter?
Resistance is inversely proportional to the radius of the vessel to the 4th power
What should you monitor in a patient that may have a coagulopathy?
Platelet count
Clotting times (PT, PTT)
Antithrombin
Fibrin degradation products/D-dimers
Thromboelastography
What is the most accurate way to monitor fluid balance?
Serial, consistent body weight measurements
What heart rate is concerning in dogs? Cats?
Dogs: tachycardia (>140 bpm)
Cats: bradycardia (<160 bpm)
What can cause a decrease in heart contractility?
Sepsis
SIRS
Primary heart disease
More than what percent of blood oxygen is carried by hemoglobin?
98%
Under normal conditions, what is the concentration of oxygen in the blood?
20 mL O2/dL
What is the difference between hyperthermia and fever?
Hyperthermia: increase in temp caused by external source
Fever: temp elevated from within (stimulation of pyrogens, elevated set point in hypothalamus)
What is the “Rule of 4”?
Normal values for Na, K, and pH
Na: 140
K: 4
pH: 7.4
What are the normal Na/K ratios for extracellular fluid? Intracellular?
Extracellular: High Na, low K
Intracellular: Low Na, high K
What molecule is the biggest determinant of water balance?
Na+
What are the two types of fluid loss and how quickly can they be replaced?
- Dehydration = interstitial/intracellular fluid loss. Replace slowly.
- Hypovolemia = intravascular fluid loss. Replace rapidly!
What are clinical signs of hypovolemia?
Tachycardia Prolonged CRT Hypotension Hypothermia, cool extremities Weak pulses Weakness, lethargy
How do you initially address hypovolemia?
Give fluid boluses of 10-20 mL/kg isotonic fluids and then reassess.
What type of fluid should be avoided in patients with liver disease?
Lactate-buffered solutions
Thought to mess with acid/base
Why should plain water never be given IV?
It causes a rapid shift of water intracellularly, causing blood cell swelling and death
What are the differences in Na/K ratios in maintenance fluids vs replacement fluids?
Maintenance: Low Na/Cl, high K (hypotonic)
Replacement: High Na/Cl, low K (isotonic)
What are hypertonic fluid used for?
Rapid volume expansion or reduction of intracranial pressure
What are contraindications of hypertonic fluids?
Severe dehydration
Hypernatremia
What is hypertonic saline?
Usually 7.2 - 7.5% saline (2400 mOsm)
Expands blood volume 3-2.5 the amount administered
4ml/kg IV over 5 min
What are the proposed benefits of hypertonic saline?
Rapud intravascular volume expansion
Decreases cerebral edema
Increased cardiac contractility
Immunomodulatory effects
Improved microcirculatory perfusion due to arteriolar vasodilation
What are the adverse effects of hypertonic saline?
Hypernatremia
Bradycardia
Hypotension
Bronchoconstriction
What do you need to remember about mannitol?
Must be kept warm to prevent crystallization
Should be administered through a filter
When do you discontinue fluid therapy?
Rehydration is complete
Patient is eating and drinking sufficiently
On-going losses are under control
What are colloids?
Fluids that contain large, insoluble molecules that do not freely cross a semi-permeable membrane
Act to hold water within vascular space for a longer duration than crystalloids
Which starling force explains why a hypoproteinemic animal can have pitting edema but no pulmonary edema?
Hydrostatic pressure
What is the main contributor to intravascular volume?
Albumin
What is colloid osmotic pressure?
Pressure exerted by large molecules the water it pulls across membranes
Measured using a colloid osmometer
Albumin generates 80% COP
What are the proposed effects of colloids?
Longer intravascular effects
Smaller volume requirements for intravascular expansion
Less dilutional coagulopathies
Decreased tissue edema formation
What characteristic of a molecule most influences serum osmolality?
CHARGE
Size doesn’t matter
What is the Gibbs-Donnan Effect?
Because electroneutrality must be maintained, Large negative proteins (such as albumin) draw positive ions (Na+) and water across semi-permeable membranes
Increases the COP 7-8mmHg
What are examples of natural colloids?
Albumin
Blood products (NOT packed RBCs)
Why should you never administer human albumin to a healthy patient or a patient that has received human albumin in the past?
Severe anaphylaxis
Delayed hypersensitivity reactions
Death
How do you calculate the albumin deficit?
Alb Dft = 10 x [Ab (desired) - Ab(patient)] x BW x 0.3
What is the primary synthetic colloid used in vet med? What are the potential adverse effects?
Hydroxyethyl Startch (Hetastarch, Pentastarch, Tetrastarch)
Acute renal failure
Anaphylaxis
Immunosuppression
Volume overload
Coagulopathy
What characteristic of a solution is most correlated with decreased coagulation?
Higher degree of substitution
What effect will colloid administration have on urine SG?
Increase it
What are non-cardiac causes of elevated heart rate?
Poor perfusion
Anemia
Pain/anxiety
What is the “shock triad” in cats?
Bradycardia
Hypothermia
Hypotension
Fluids with osmolalities >600mOsm should only be administered through what?
Central line
What will causes the biggest decrease in flow through a catheter?
Halving the diameter of the catheter
Poiseuille’s Law: Flow is proportional to diameter ^ 4
What are the most common sites for placing a central line?
Jugular v
Medial and lateral saphenous v
What are possible complications of catheterization?
Phlebitis
Thrombosis
Catheter embolism
SQ fluid infiltration to surrounding vein
Infection
Hemorrhage
What is the seldinger technique?
Use of a smaller introducing catheter or trochar + guide wire to gain access to vessels or hollow organs
May also be used to replace an existing catheter in the same location
What is the biggest disadvantage to IO catheterization?
Patient discomfort
Limited to 29mL/min
What complications are associated with IO catheterization?
Fat embolism
Infection
Extravasation of fluids
Compartment syndrome
Bone fractures
What is the difference between the thoracic and cardiac pump techniques for CPR?
Thoracic pump: pump at highest point on chest (large dogs)
Cardiac pump: pump above heart (small dogs, cats)
What is an ideal compression:ventilation ratio for CPR?
30:2
What are the shockable cardiac rhythms?
V fib
Pulseless V tach
When is open chest CPR indicated?
Tension pneumothorax
Pericardial/pleural effusion
Thoracic wall trauma
Diaphragmatic hernia
Prolonged closed chested CPR
What are the 4 cardiac rhythms associated with arrest?
Asystole
Pulseless electrical activity
Pulseless V tach
V fib
What is post-cardiac arrest syndrome?
Multiorgan failure
Cardiogenic shock
Anoxic brain injury
Sequela or pre-existing diseases
What antibiotic is associated with neuro signs at high does?
Metronidazole
Which antibiotics are known to be nephrotoxic?
Aminoglycosides
What patient risk factors are associated with antibiotic resistance?
Prior antibiotic use (within the last 90 days)
Hospital acquired infection
Long-standing infection
Surgical implants
What antibiotic would you use to treat puppy pneumonia?
Healthy, outpatient: doxy
Sick, outpatients: potentiated penicillins
Sick, inpatient: Potentiated penicillins + fluoroquinolone or chloramphenicol
What antibiotic would you use to treat adult pneumonia?
Community-acquired: potentiated penicillins + fluoroquinolones
Hospital -acquired: potentiated penicillins + aminoglycoside OR carbapenems
What antibiotic would you use to treat septic peritonitits?
Community-acquired: penicillins + fluoroqionolone or 3rd gen ceph
Hospital-acquired: penicillins + aminoglycoside + metronidazole OR imipenem
What antibiotics would you give to treat an animal bite?
penicillins or potentiated penicillins
What antibiotic would you use to treat a UTI?
1st gen ceph
Penicillins
What are the 4 types of coagulation abnormalities in snake bit envenomations and which is the most common?
- Combined fibrinogenolysis amd thromocytopenia most common
- Fibrinogenolysis
- Thrombocytopenia
- DIC
What is the Snake Bite Severity Score?
Used to classify severity and dose of antivenom
0-20 (20 is worst)
How do you treat a snake envenomation?
IV crystalloid
Antivenom
Glucocorticoids/antihistamines for hypersensitivities only
Why should you avoid NSAIDs with snake envenomations?
NSAIDs prevent platelet aggregation
When is the optimum time to give antivenom?
Within first 4 hours of bite
Which type of antivenom is associated with the least amount of hypersensitivity reactions?
Fab1
What should you know about hemolytic anemia associated with elapid bites?
Hemolysis occurs in dogs but not in cats
What are the components of bee venom and what are their actions?
- Melitin: hydrolyzes cell membranes, histamine release
- peptide 401: mast cell degranulation
- Phospholipase A: major Ag that causes hemolysis
- Hyaluronidase: spreading factor
What causes the intense paid in vespid envenomations?
Serotonin, kinins, acetylcholine
What are the active components of hymenoptera envenomation?
Vasoactive amines, acetylcholine, kinins
Urticaria, angioedema, laryngeal edema, circulatory collapse, shock are all signs of what?
Anaphylaxis
What are predisposing factors for having severe reactions to bee stings?
Beta blockers
ACE inhibitors
What do you give for an animal in anaphylaxis?
Epi 0.01mg/kg IM
Stabilizes mast cells
A pustule is indicative of what kind of envenomation?
Fire Ant
What is the main component of black widow venom and what does it do?
Alpha-lactrotoxin
Induces massive neurotransmitter release
Cats are VERY PAINFUL
How do you treat black widow envenomation?
Antivenom
Narcotic analgesics
Antihypertensives
Benzodiazapines
What is the best sedative for an animal in respiratory distress?
Butorphanol
What are the 3 most important things to do for an animal in respiratory distress?
- Hands off
- Oxygen
- Sedation
What are the landmarks for thoracocentesis?
8th/9th intercostal space
What can you give to increase strength of contractions? Frequency of contractions?
Strength - calcium
Frequency - oxytocin
What are the indications for surgical intervention in a dystocia?
Obstructed
Fetuses stressed or dead
Oversize
Sick queen or bitch
Failed medical tx
What are surgical emergencies in a dystocia?
Uterine torsion
Uterine rupture
What is the main clinical sign associated with penile trauma?
Hematuria at the end or urination
What disease should you be concerned with in patient with testicular abscess?
Brucella
What is the difference between paraphimosis, priapism, and phimosis?
Paraphimosis: protrusion of nonerect penis without ability to retract
Priapism: persistent erection without sexual stimulation
Phimosis: inability to extrude penis from prepuce
What is the expected weight gain of neonatal puppies and kittens?
Puppies: 1g per lb of adult weight
Kittens: 7-10 grams per day
In neonates, bradycardia and hypotension are usually due to what?
Hypoxemia
HR <150bpm
What 3 reflexes can asses neurologic function in neonates?
Righting reflex
Rooting relfex
Suckle reflex
What is the fluid requirement for neonates?
80-100ml/kg/day
What is a normal PCV for a neonate?
Around 30
Any higher-> dehydration
What antibiotics can you use safely in neonates?
Metronidazole
B lactams
What is neonatal isoerythrolysis?
Immune-mediated destruction of kitten’s erythrocytes by queen’s antibodies
Kittens with A or AB blood nursing from type B queen
Queen passes anti-A IgG Ab in colostrum
What causes a high anion gap?
“DUEL”
Diabetic ketoacidosis
Uremic acids
Ethylene glycol
Lactate
What causes a metabolic acidosis?
High AG, normoCl-: shock/high lactate, DKA, renal failure, toxins
Normal AG, hyperCl-: diarrhea
What causes a metabolic alkalosis?
Upper GI obstruction, vomiting, loop diuretics, liver failure, Cushings
What causes respiratory alkalosis? Acidosis?
Alkalosis: hyperventilation
Acidosis: hypoventilation
What are the classifications of shock?
Hypovolemic: decrease in circulating blood volume
Cardiogenic: decrease in forward flow
Distributive: decrease or increase in SVR or maldistribution of blood
What are the different types of hyperlactatemia?
A: increased oxygen demand, struggling
B1: associated with underlying disease
B2: drugs or toxins
B3: inborn errors of metabolism
The hyperdynamic phase of sepsis is characterized by what?
Bounding pulses Injected mucous membranes Fever tachycardia tachypnea
How can you determine septic peritonitis from ab tap?
Lactate difference >2 mmol/L
Glucose difference >20 mg/dL
What is the MOA of isotonic crystalloids in lower urinary blockage?
Dilution
What is the MOA of albuterol or theophylline in lower urinary blockage?
Activates Na/K pump to push K intracellularly
How can you diagnose uroabdomen from ab tap?
Creatinine 2:1
Potassium 1.4:1
What are lung crackles suggestive of? Dull lung sounds?
Pulmonary contusions
Pleural space disease
What does Schiff Sherringotn posture suggest?
Thoracolumbar spinal injury
What tests are part of the minimum emergency database?
PCV and TP
Glucose
BUN/creatinine
Lactate
A TS less than what value is indicative or hemorrhage?
<6
What are common sources of internal bleeding at may not initially be apparent?
Femoral fracture
Pelvic fracture
Hemoabdomen
What injury may contribute to hyperglycemia? Hypoglycemia?
Hyper: traumatic brain injury
Hypo: bite wounds, sepsis
Analysis of abdominal effusions
PCV/TS close to blood = hemorrhage
Creatinine and K higher than blood = uroabdomen
Glucose and lactate low = sepsis
Bilirubin higher than blood = bile
What toxic compound is acetaminophen converted to and why is it so toxic to cats?
NAPQI via CP450
Glucoronidation is limited in cats
What is a common clinical sign of acetaminophen toxicity?
Chocolate brown MM
Vasculitis/puffy face in cats
Why will pulse ox be inaccurate in patients with acetaminophen toxicity?
Methemoglobinemia distorts SPO2
What is the best treatment for acetaminophen toxicity?
N-acetylcisteine
Increases availability of glutathione and coverts NAPQI to non-toxic conjugates
What is serotonin syndrome? How do you treat it?
Certain drugs can increase serotonin levels ( antidepressants, opioids)
Leads to excessive serotonin in CNS
Leads to altered mentation, autonomic signs, neuromuscular weakness
Tx with cyproheptadine and decontamination
What is the main concern with phenylpropanolamine (proin) overdose?
Severe hypertension
What are the negative effects associated with albuterol overdose?
Thermal burns in mouth
Tachycardia
Severe temporary hypokalemia
How do you treat the muscarinic and nicotinic signs of anticholinesterase toxicity?
Muscarinic: atropine
Nicotinic: 2 PAM
What are the two clinical syndromes of xylitol toxicity?
Hypoglycemia (early)
Liver failure (delayed)
(Activated charcoal not helpful)
What is the treatment of choice for tremors in mold toxicity?
Methocarbamol
How is bread/pizza dough toxic and when is it okay to decontaminate?
Yeast produce ethanol, which interferes with NMDA receptors
Okay to decontaminate if patient isn’t drunk yet
What is the MOA of garlic/onion toxicity?
Oxidative damage to hemoglobin (heinz bodied, eccentrocytes, hemolysis)
What are the toxic metabolites of ethylene glycol?
Glycoaldehyde
Glycoxylic acid
What is the test of choice to assess anticoagulant rodenticide toxicity?
Prothrombin (PT)
Factor 7 depletes earliest
How do you treat hypercalcemia associated with Vit D3 toxicity?
0.9% NaCl diuresis
Furosemide
Corticosteroids
How do you treat sago palm toxicity?
Cholestyramine
Hepatoprotectants
Supportive care
What are the two main toxicities seen with mushroom toxicity?
Hepatotoxicity
Muscarinic signs
Which genus of lillies are toxic?
Lilium or Hemerocallis
Tiger, Day, Easter, Stargazer
How is fluid resuscitation with isotonic crystalloids associated with coagulopathy?
Dilution of clotting factors
Acidemia
Hypothermia
Why do citrate-containing transfusions worsen coagulopathy?
Makes Ca drop
Citrate toxicity
What are the 4 injuries to rule out in roll-over injuries?
Bldder rupture
Pelvic fractures
Body wall rupture
Diaphragmatic hernia
What is the definition of AKI?
Inc creatinine by >0.3 mg/dL within 48 hrs
Inc creatinine > 1.5 times baseline
Urine production < 0.5 ml/kg/hr (normal is 1-2)
