Exam 1 Spring

Question 1

Triage Steps

Answer 1

o Airway/Breathing
o Cardiovascular/circulation
o Neuro
o Abdominal organs
o Musculoskeletal
o Integument

Question 2

Pulmonary Contusions

Answer 2

o Alveoli filled with blood & edema fluid
o Results in atelectasis & hypoxemia
o Radiographically appears as an infiltrate
o May not appear on rads until 12 hours after trauma

Question 3

Pneumothorax; What is it? How to treat?

Answer 3

atelectasis, hypoxemia, & interference w/ venous return

Thoracocentesis
 preferred initial therapy
 Aspirate both chest sides

Thoracostomy tube if have to tap chest >2x
 Negative pressure never achieved during thoracocentesis

Question 4

Rib Fractures

Answer 4

o pain & limited chest wall motion
o Results in atelectasis & hypoxemia
o Imperative that analgesia be given once hemodynamically stable

Question 5

Fluid PCV equal/greater than peripheral PCV

Answer 5

 Splenic, hepatic, or renal parenchymal laceration
 Many cases can be treated conservatively

Question 6

Urological Injury due to Trauma; Diagnosis, Management

Answer 6

o PCV of ab fluid < PCV of peripheral
o BUN/creat of ab fluid >2x peripheral

Emergency Management
 Drainage of urine via indwelling urinary catheter or abdominal drain
 Surgical repair once patient stable

Question 7

Musculoskeletal Injury due to Trauma

Answer 7

o Not life threatening
o Damage to nerves, blood vessels, & soft tissue is of greater importance
o Blood loss from femur and pelvic fractures can be tremendous in large dogs

Question 8

Steps to Interpreting Arterial Blood Gases

Answer 8

Origin of blood; veinous or arterial

Oxygenation status
 If hypoxemic, do A-a gradient

Ventilatory status

Assess acid/base status

Question 9

Determine Acid/Base Status

Answer 9

FIRST pH
 Alkalosis or acidosis

PaCO2
 High – respiratory acidosis
 Low – respiratory alkalosis

HCO3
 High – metabolic alkalosis
 Low – metabolic acidosis

Question 10

Hypovolemic Shock; Causes, Treatment

Answer 10

Causes
 Whole blood loss
 Plasma loss through GI or hepatic failure
 Isotonic Loss (severe dehydration)

Treatment
 Isotonic crystalloids as fast as possible
 90ml/kg in dogs
 60ml/kg in cats
 Hypertonic saline for those w/ brain injury

Question 11

How to Know Your Shock Patient is Stable

Answer 11

o Normalization of clinical perfusion parameters
o Improved blood pressure (MAP ≥ 65 mmHg)
o Clearance of plasma lactate (< 2.5 mmol/L)
o Normal urine output (≥ 0.5 ml/kg/hr)

Question 12

Cardiogenic Shock; Causes, Treatment

Answer 12

Causes
 Altered heart rate
 Valvular regurgitation
 Decreased contractility

Treatment
 NO fluids
 Lidocaine bolus for tachycardia
 Atropine for bradycardia
 Dobutamine or Pimobendan for decreased systolic function
 Furosemide & O2 if heart failure

Question 13

Distributive Shock; Causes

Answer 13

Decreased systemic vascular resistance
 Inflammatory mediators
 Sepsis/ SIRS (e.g., septic peritonitis, pancreatitis)
 Anaphylactic reactions (e.g., bee sting)

Decreased venous return (”Obstructive shock”)
 GDV / Mesenteric torsion
 Tension pneumothorax
 Cardiac tamponade

Question 14

Distributive Shock; Treatment

Answer 14

 Increase preload w/ fluids
 Restore venous return by fixing underlying problem
 Epinephrine bolus or CRI for anaphylaxis
 Norepinephrine & antibiotics for Sepsis/SIRs

Question 15

Basics of CPR Compressions

Answer 15

• Uninterrupted cycles of 2 minutes of chest compressions
• Most patients in lateral recumbency
• 100-120 compressions per minute
• Compress 1/3 to 1/2 of the thorax

Question 16

Where to perform CPR on Round Chested Dogs

Answer 16

 Lateral recumbency
 Widest portion of the chest

Question 17

Where to perform CPR on Keel Chested Dogs

Answer 17

 Lateral recumbency
 Directly over the heart

Question 18

Where to perform CPR on Barrel Chested Dogs

Answer 18

 Dorsal recumbency
 Over the sternum

Question 19

Where to perform CPR on Cats & Small Dogs

Answer 19

 Directly over the heart
 One- or two-handed techniques

Question 20

Basics of CPR Ventilation

Answer 20

• FiO2 of 100%
• 10 breaths per minute
• 10 ml/kg tidal volumes
• Administer breath over 1 second

Question 21

Presentation of L Vs R Sided CHF

Answer 21

L sided
* Dog: pulmonary edema
* Cat: pulmonary edema, pleural effusion

R Sided
* Dog: pleurale ffusion, ascites
* Cat: pleural effusion, ascites(uncommon)

Question 22

Initial Exam Findings of CHF

Answer 22

Dog
* Respiratory distress
* Murmur
* crackles

Cat
* Respiratory distress
* Crackles or decreased lung sounds
* murmur

Question 23

Stabilization & Treatment for CHF

Answer 23

Stabilization
 O2
 Anxiolytics
 Furosemide
 Thoracocentesis for plural effusion

Treatment
 Pimobendan (have to wait until pt can swallow)
 Dobutamine
 Nitroprusside
 Enalapril or benazepril
 Clopidogrel for cats

Question 24

Cardiac Tamponade; Presentation, Initial Exam

Answer 24

Presentation
 Rare in cats & common in dogs
 Exercise intolerance
 abdominal enlargement
 tachypnea, labored breathing
 weakness, collapse or syncope
 cough
 inappetence
 vomiting

Initial Exam
 Tachycardia
 Pale MMs
 Prolonged CRT
 Muffled heart sounds
 Pulsus paradoxus
 Paricardial effusion +/- pleural effusion +/- ascites
 electrical alternans on ECG

Question 25

Cardiac Tamponade; Stabilization

Answer 25

 Pericardiocentesis
 Thoracocentesis
 Abdominocentesis
 IVF crystalloid bolus (if no L atrium rupture)
 Antiarrhythmic

Question 26

Symptoms of Hypo & Hypernatremia

Answer 26

o Obtundation
o Head pressing
o Seizures
o Coma
o Death

Question 27

Symptoms of Hypo & Hypercalcemia

Answer 27

Hypocalcemia
o Muscle tremors
o Facial rubbing
o Seizures
o Tachycardia

Hypercalcemia
o PU/PD and anorexia in dogs
o ADR cats

Question 28

Symptoms of Hypo & Hyperkalemia

Answer 28

Hypokalemia
o Muscle weakness
o Ventroflexion of head and neck
o Cardiac arrhythmias
o Respiratory muscle paralysis

Hyperkalemia
o bradycardia