exam 4 Flashcards
what are the four types of shock
hypovolemic, cardiogenic, obstructive, maldistributive
what is the first sign of shock
increased heartrate
what makes offloading of oxygen to tissues easier
acidosis in the tissues, increase in 2, 3 DPG
what is the range for daily fluid requirements
40-60 ml/kg/day
how do we calculate hydration deficits
body weight * % dehydration in decimal form = dehydration in liters
when do we not give oral fluids
GI dysfunction
what can we not give SQ fluid wise
hypertonic solutions
what is our fluid choice for replacement
isotonic crystalloid
what is our fluid choice for maintenance
hypotonic crystal
when do we give colloids
hypoalbuminemia
how quickly do we administer fluid in acute situations
6-8 hours
what is the formula for transfusion amounts
BW * amount of blood (%) * (desired PCV - current PCV) / PCV of Donor
how much blood can you take from a donor
25% of their total estimated blood volume BW * .08 * .25
what type of anemia is caused by anaplasma
extravascular hemolysis
when are blood transfusions recommended in large animal? In small animal?
<18% acutely
<12% chronically
clinical signs
< 15% in SA
what are the signs of red maple toxicity
weakness, methemoglobinemia, normal PCV, intravascular hemolysis
how much blood can a horse lose and live
1/3 of their total blood BW * 8%
when do you do blood transfusions in dogs and cats
if PCV <15% in chronic cases
how do you tell the difference between infectious anemia and IMHA
infectious causes thrombocytopenia which is not seen in IMHA
signs of IMHA and infectious anemia
lethargy, anorexia, fever, icterus, splenomegly
what are treatments for IMHA
transfusion, prednisone, +- other immune suppressants ( azathioprine, myco, cyclosporine)
what do we need to remember about cyclosporine
no vegetable oil versions
most common secondary causes of IMHA in dogs
babesia and blasto
most common secondary causes of IMHA in cats
mycoplasma and FeLV
what does iron deficiency look like
microcytic, hypochromic, lots of fragmentation, nonregenerative
when do we treat chronic kidney disease that is causing anemia of chronic disease. how do we treat
only with severe clinical signs and PCV is really low,
exogenous erythropoietin darbepoietin
what does anemia of chronic disease look like
mildly low PCV with all the cells are normal looking and normal sized.
what is the treatment for oxidative hemolysis
N-acetylcysteine IV to reduce oxidative damage, remove toxin, charcoal
what would blood work from an oxidative patient look like
heinz bodies, eccentrocytes, spherocytes +- methoglobinemia, extravascular hemolysis: splenomegaly, biliruminemia-uria
what are our causes of extravascular hemolysis
IMHA, oxidative, infectious
what is a good way to tell hemolysis from hemorrhage?
look at total protein levels
how does plasma appearance help dictate types of hemolysis
extravascular: icterus
intravascular: hemolyzed
heinz bodies, regenerative anemia, and ghost cells in cats?
oxidative hemolysis
four main categories of thrombocytopenia
SPUD
sequestration- -megaly
production down- bone marrow or liver
utilization- DIC
destruction- IMTP
if we have an increase PT and PTT what are we thinking
vit K deficiency, DIC liver failure
cant produce clotting factors or they are used up
what causes severe thrombocytopenia
IMTP
treatment for IMTP
doxy, pred, +- vencristine, +- fresh whole blood or packed cells
what is the test for vWB dz
BMBT after you measure PTT/PT and look at platelet count
gold standard treatment for vWB dz? what else can we do
give cryoprecipitate,
or FFP or desmopressin
prolonged PTT and normal PT?
hemophilia a/b
DIC early stages- check ddimer or fdp
treatment for rodenticide tox
vit K SQ injection
FFP
increased Ddimer, prolonged PTT then PT, schistocytes
DIC
who benefits from fresh whole blood
those who need RBC for anemia and the clotting factors and platelets from the plasma.
what is a common cause of iron deficiency
chronic hemorrhage, GI hemorrhage look for decreased BUN
do red maple tox patients need blood transfusion if their PCV is high?
yes. oxidative damage can cause methemoglobinemia which can’t carry oxygen
what are bad signs of a transfusion
tachycardia and vomiting. stop transfusion
treatment for IMHA
packed cell transfusion and immune suppression.
what does liver have an effect on in regards to blood production? what about the kidneys?
thrombopoietin= liver
erythropoietin= kidney
what are general signs of platelet deficiency vs coag factor deficiency
platelet: multifocal hemorrhage, petechiae, mucosal surface bleeding
factor: body cavity bleeding localized
bounding pulses vs weak pulses should help us decide what
hemorrhage vs hemolysis
hemorrhage should have weak pulses due to loss of blood.
what are the four causes of a regurg murmur
physiologic - anemia
valve dysplasia- MVD
valve annular disease: DCM
valvular endocarditis
if we have iron deficiency we can rule out (most of the time) what form of anemia
hemolysis because the body would reuse the iron and wouldnt run out
what is the most supportive finding for regeneration in a blood smear (SA)
polychromasia
when are NRBCs allowed
if there are retics present. if there are no retics then this supports bone or spleen disease
what are the four major categories of shock
hypovolemia
cardiogenic failure
obstructive
maldistributive
what are the four ways the body tries to compensate for shock
increase vascular tone and reserve water
increase CO: inc HR, SV
preferentially redistribute blood
optimize offloading of blood to tissues
what do we never do to cardiogenic shock patients?
give them fluid. this increases the work load on the already struggling heart
