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saecc > exam 1 - SIRS and shock > Flashcards

exam 1 - SIRS and shock Flashcards

1
Q

define shock

A

state of inadequate cellular energy production
decreased delivery of oxygen to tissues
inadequate utilization of oxygen and/or decreased energy production

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2
Q

where is the bulk of ATP made - glycolysis or ETC

A

ETC

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3
Q

big 3 ends to cellular dysfunction

A

necrosis - organ failure - death

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4
Q

equation for oxygen delivery to tissues

A

DO2 = CaO2 x CO

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5
Q

CaO2

A

oxygen content in arterial blood
(1.34 x Hb x SaO2) + (0.003 x PaO2)

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6
Q

CO

A

cardiac output
CO = HR x SV

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7
Q

classic causes of shock(four)

A

hypovolemic, cardiogenic, distributive, obstructive

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8
Q

extra classification of shock

A

hypovolemic, cardiogenic, distributive, metabolic, hypoxemic

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9
Q

how much body fluid does ECF take up

A

33%
plasma volume and interstitial volume

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10
Q

how much of ECF does plasma and interstitial make up

A

1/4 plasma, 3/4 interstitial

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11
Q

dehydration

A

decrease in total body water
intracellular and interstitial

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12
Q

hypovolemia

A

decreased circulating plasma volume

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13
Q

absolute hypovolemia

A

intravascular volume lost - out of body

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14
Q

relative hypovolemia

A

intravascular volume is lost from the normal space

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15
Q

what is the most important aspect of shock treatment

A

early recognition

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16
Q

primary goal of shock tx

A

restoration of appropriate oxygen delivery to tissues

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17
Q

what are some ways to restore oxygen delivery

A

correct hypovolemia, increase CO, address hypoxemia and hypoglycemia, target appropriate renal perfusion

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18
Q

what happens in hypovolemic shock

A

decrease in circulating blood volume
decreased preload, SV, CO and DO2

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19
Q

history and PE of hypovolemic shock

A

vomiting diarrhea, PU/PD, lethargic, trauma
increased HR, fair to poo pulse, pale MM, long CRT, recumbent, cool extremities

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20
Q

noninvasive diagnostics of hypovolemic shock

A

BP < 90-100 mmHg
sinus tachycardia on ECG
effusion on FAST scan
hyperlactatemia
thrombocytopenia - hemorrhage

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21
Q

what is first stage of shock

A

compensatory - activation of neurohurmonal response, hyperdynamic
normal to slightly elevated CS

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22
Q

what is second stage of shock

A

early decompensatory - redistribution of blood flow to essential organs, shift to anaerobic metabolism
altered CS here, seems shocky

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23
Q

third stage of shock

A

decompensatory - failure of autoregulation, loss of sympathetic control
terminal if not treated

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24
Q

how do cats with shock present

A

bradycardia, hypothermia, hypotension
miss compensatory phase in cats

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25
Q

how to treat hypovolemic shock

A

fluids or blood products

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26
Q

“dose” for crystalloids

A

10-20 ml/kg over 10-15 min
dont exceed total blood volume (90 dogs, 60 cats)

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27
Q

dose for hetastarch

A

4-5 ml/kg or 2-3 in cats
max 20 dogs and 10 cats

28
Q

dose for hypertonic saline

A

3-5 ml/kg bolus over 20 min

29
Q

what can happen if hypertonic saline given rapidly

A

refractory hypotension

30
Q

colloids remain in the _______

A

intravascular compartment
expand the IV volume and draw fluid in

31
Q

do crystalloids or colloids have more potential for negative effects

A

colloids - avoid in sepsis
coagulopathies, renal injury

32
Q

when is hypertonic saline contraindicated

A

dehydrated or hyperosmolar patients

33
Q

what catheters deliver fluids faster and why

A

large bore, short catheters
doubling catheters radius will increase flow 16x
Poiseuilles law

34
Q

what is resuscitation to endpoint mean

A

tailor resuscitation to patient endpoints
normotensive, improved lactate/acid-base

35
Q

what type of shock do we avoid fluids

A

cardiogenic shock

36
Q

why does cardiogenic shock occur

A

decrease in CO due to pump failure

37
Q

what conditions can cause cardiogenic shock

A

CHF, DCM, HCM, severe arrhythmias

38
Q

CS of cardiogenic shock

A

cyanosis, resp distress, abnormal auscultation, hypotension, poor pulses, depressed, jugular distension

39
Q

how to treat cardiogenic shock

A

diuretics, positive inotropes, antiarrhythmics, vasodilators

40
Q

what is distributive shock

A

obstruction of blood flow or maldistribution of blood

41
Q

what conditions can cause distributive shock

A

sepsis, anaphylaxis, GDV, mesenteric torsion, heartworm, saddle thrombus, pneumothorax

42
Q

how to treat obstructive conditions

A

relieving obstruction is most important goal to restore perfusion
GDV - trocar then surgery
heartworm - extract worms
saddle thrombus - anticoagulants
pneumothorax - thoracocentesis

43
Q

how to treat anaphylaxis

A

IV crystalloid bolus, consider epi, antihistamines, steroids for flare ups

44
Q

additional therapies for sepsis

A

IV crystalloid bolus, early Abx, catecholamines, source control
vasopressor/inotropic support

45
Q

what are causes for metabolic shock

A

hypoglycemia, cyanide

46
Q

causes of hypoglycemia

A

insuline OD, xylitol, addisons, sepsis, insulin secreting tumors

47
Q

treatment of hypoglycemia

A

dextrose bolus with crystalloids

48
Q

is cyanide common in vet med

A

no
smoke inhalation, Na nitroprusside

49
Q

cyanide pathophysiology

A

reversible binding of cytochrome oxidase-3 in mitochondria
stops cellular respiration - stops reduction of oxygen to water

50
Q

reasons for hypoxemic shock

A

anemia, CO, hypoxemia

51
Q

tx for anemia

A

transfusions of packed RBC

52
Q

tx for CO

A

oxygen therapy
reduces oxygen carrying capacity of Hg and ability to release oxygen to tissue

53
Q

tx for hypoxemia

A

oxygen, sedation

54
Q

what is SIRS

A

systemic inflammatory response syndrome
body wide inflammatory response to local insult
secondary to infectious insult or endogenous inflammatory mediators

55
Q

relationship between SIRS and shock

A

SIRS can cause shock and be caused by shock

56
Q

signs of SIRS in dog

A

low or high temp
tachycardia
tachypnea
low or high WBC
increased band cells

57
Q

signs of SIRS in cats

A

low or high temp
low or high heart rate
tachypnea
low or high WBC
high band cells

58
Q

sepsis is ____ + ______

A

SIRS, bacteria

59
Q

non-infectious etiologies of SIRS

A

heatstroke, burns, pancreatitis, trauma, snake venom, immune mediated

60
Q

pathophysiology of SIRS

A

local inflam - activated AA cascade - release of pro-inflam mediators - activate target cells - system wide release of mediators - secondary negative effects

61
Q

consequences of systemic inflammation

A

multiple organ dysfunction and death

62
Q

MODS

A

severe acquired dysfunction of 2+ organ systems for longer than 24-48 hrs
harder to fix

63
Q

what to do before diagnostics for SIRS

A

stabilize

64
Q

diagnostics for SIRS

A

blood gas, electrolytes, lactate, USG, AFAST, CBC, chem, coagulation

65
Q

SIRS tx

A

Abx - broad spectrum - unisyn and baytril
GI protectants
nutrition
resp support
recumbency care
serial monitoring

66
Q

prognosis of SIRS

A

depends on severity, organs, and ability to control cause
mods = worse

saecc (5 decks)

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