Final Flashcards
1
Q
Define category 1 emergency, give examples
A
Will die without immediate intervention; arrest, distressed or not breathing (open mouth in cats), pale or blue gums, severe arrhythmias, hemorrhage, etc
2
Q
Define category 2 emergency, give examples
A
Critical, needs attention within 30 min; pale, severe fever, dystocia, LUT obstruction, severe dehydration
3
Q
Define category 3 emergency, give examples
A
Sick, needs attention within hours; minor allergic rxn, laceration, stable fracture, V/D
4
Q
Define category 4 emergency, give examples
A
Not true emergency, tx within 24 hours; V/D w/o dehydration, abrasions/cute, broken nail, sneezing/URT, hematuria
5
Q
Most common cause of bradycardia
A
AV block
6
Q
Causes of atrial standstill
A
hyperK (UO, Addisons), cardiac dz, hypothermia
7
Q
Most common cause of weak pulses
A
Hypovolemia
8
Q
Bounding pulses indicate what
A
Compensated hypovolemia
9
Q
MM and CRT in: compensated hypovolemia
A
Injected,
10
Q
MM and CRT in: hypoxia
A
cyanotic
11
Q
MM and CRT in: anemia (normal or severe)
A
N: pale, normal CRT; severe: pale, absent
12
Q
Pale MM with delayed CRT indicates
A
Decompensated shock (past compensation and progressing)
13
Q
Most common type of breathing increase
A
Inspiratory
14
Q
Localize- inspiratory effort
A
Upper airway (or abdominal distension, pleural space dz, diaphragmatic hernia)
15
Q
Localize- expiratory effort
A
Lower airway (bronchitis, asthma)
16
Q
PTE, pain and abdominal distension will likely cause what pattern of breathing
A
non-specific dyspnea
17
Q
Short and shallow breathing indicates
A
Parenchymal dz or pleural space dz pr diaphragmatic hernia
18
Q
Causes of paradoxical breathing
A
pneumothorax, pleural space dz, diaphragmatic hernia
19
Q
Respiratory manifestations of parenchymal dz
A
mixed insp/exp dyspnea, harsh, loud sounds or crackles, short and shallow
20
Q
Levels of consciousness
A
Coma- stupor- obtunded- dull- quiet- bright
21
Q
Respiratory manifestations of pleural space dz or diaphragmatic hernia
A
inspiratory effort, short/shallow, quiet, +/- paradoxical
22
Q
Respiratory manifestations of lower airway dz
A
Expiratory effort, harsh sounds/crackles, wheezing
23
Q
Respiratory manifestations of upper airway dz
A
Inspiratory effort, stridor, referred upper airway noise on auscultation
24
Q
MDB in triage
A
PCV/TS, glucose (esp neonates), renal, electrolytes (esp K)
25
Tx ventricular arrhythmias
Lidocaine (1/10th dose in cats)
26
Tx severe bradycardia
Atropine (fix electrolytes, warm, reverse opioids)
27
Blood typing- dogs vs cats
Not needed in first time dogs, mandatory in cats
28
Tx seizures
Diazepam IV or rectally
29
Tx ICP
Mannitol or hypertonic saline
30
Why do we monitor
ID problem for early intervention- monitoring always resulting in action
31
BP =
CO x VR (vascular resistance) (CO= HRxSV)
32
Limitations to CO
Dog \>180- decreased SV maxes out CO
33
Vascular resistance formula
Inversely proportional to radius of tube to 4th power
34
What is the hidden killer in ECC, most patients susceptible to?
Thrombosis
35
Where to monitor for coagulation issues
Gums, pinnae, ventral abdomen
36
Common electrolyte disturbance in ECC patients
hypoK and hypoCa
37
Electrolyte imbalance in refeeding syndrome
hypoGly, hypoK, hypoP, hypoMg (all shift intracellularly when food introduced and insulin responds)
38
Dog and cats max normal HR in hospital
D- 120; C: 220 (should not be lower than 160 (180?)
39
When should arrhythmias be treated
When CS present or severe tachycardia concurrent
40
What dz states can cause decreased contracility
Sepsis, SIRS, heart dz
41
Tx decreased contractility
Positive inotropes- sepsis/SIRS: dobutamine; heart dz: pimobendan/digoxin
42
What is decreased oxygen tension in the tissues
Hypoxia
43
Define hypoxemia
Decreased partial pressure of O2 or saturation of O2 in the blood
44
Hypoxemia, hypoxia: ______ can be present without \_\_\_\_
Hypoxia, hypoxemia
45
What does using the arterial oxygen content equation demonstrate?
Hgb most important in oxygen delivery to tissues, dissolved O2 only a small percentage of total oxygen (ex- normal PCV 1.5% O2 is dissolved, 15% PCV- ~4% O2 is dissolved, remainder is bound to Hgb)
46
T/F inflammation indicates infection is present
F
47
What would indicate that a patient is developing an infection or an infection is overwhelming the patient
Degenerative left shift, more immature WBCs
48
What structure modulates temperature in the patient, via what signals
Anterior hypothalamus; monoamines and cutaneous deep receptors
49
Name the mechanisms of gaining heat
Increased production: catecholamines, thyroxine, shivering; decreased loss: vasoconstriction, piloerection, postural change
50
What causes fever
Stimulation of pyrogens (IL-1), increased hypothalamic set point
51
Describe starling forces in relation to fluid flux
Fluids net movement is out of the capillaries and picked up by lymphatics to prevent accumulation- when too much leaves the capillaries, causes peripheral/pulmonary edema and third spacing of fluid (pleural effusion, ascites)
52
How frequently should PCV be checked in patients receiving fluid therapy
daily at a minimum (more frequently if also anemic)
53
What concentration determines IV volume and why
Na- because water follows sodium- "total body Na determines total body hydration"
54
What are the proportions of total body water
60% of body weight is water, 40% intercellular, 20% extracellular (5% in vessels, 15% interstitial)
55
Na/K concentrations in and out of cell
Na high OUT of cell, K high IN cell
56
RER water calculation
70 x BW^0.75 or [(30 x kg)+70] = mL/kg/day
57
XS - S- M- L- XL fluid maintenance guidelines
XS (neonate) 80-100, S- 60, M (and cats) 50, L 40, XL 30 mL/kg/day
58
Dehydration v hypovolemia
D: interstitial and intercellular, progresses slowly, correct slowly, no bolus H: intravascular, rapid loss and rapid correction
59
Three types of fluid loss
Sensible- U, feces, V, exudative wounds; Insensible- sweat, saliva, panting
60
Estimate fluid dehydration deficit
kg x %dehy= L
61
What % dehydrated? mild skin tenting, slightly tacky to normal MM, CRT normal
moderate 5-7%
62
What % dehydrated? hypovolemia signs, cold extremeties, shock
Critical- 10% or greater
63
What % dehydrated? prolonged skin tent, dry MM, some tachycardia
Severe 8-10%
64
How is 5% dehydration assessed
Usually via Hx, no CS present on PE
65
What two conditions must be considered in correcting fluid losses and how
Heart disease (less need), renal compromise (more need)
66
Tachycardic, prolonged CRT, hypotensive, hypothermic, cool extremities, weak pulses- Dx, Tx
Hypovolemia- Rapid correction with 10-20mL/kg isotonic bolus, then goal directed therapy
67
What are the two major determinants of fluid balance
Alb and Na
68
Tonicity refers to
Effective osmolality of a solution compared to plasma
69
Why is a weak base sometimes added to crystalloid fluids
Excess Cl in fluids binds to HCl and creates acid, so bicarb added to create appropriate pH
70
Crystalloid fluids- what compartments, what speed
All compartments at different rates
71
What makes a fluid balanced, give some examples
If it resembles the proportion of plasma (extracellular fluid); normosolR, plasmalyte 148, LRS
72
What type of solutions should be avoided in end stage liver disease and why
Lactate buffered solutions because lactate is metabolized in the liver
73
Name two "unbalanced" fluids
0.9% saline, 5% dextrose in water (D5W)
74
What happens when water is bolused IV
RBC will swell and lyse due to zero tonicity causing rapid intracellular shift
75
Name three maintenance fluids
NormosolM, 0.45% saline, plasmalyte 56
76
When are maintenance fluids used
When patient is euvolemic but not eating/drinking, never as a bolus- rarely used in vet med
77
What are the characteristics of maintenance fluids
Lower in NaCl (Na 50-70), higher in K (10-20) (because regular losses (from kidney) low in NaCl, higher in K), usually hypotonic
78
What are the characteristics of replacement fluids
Similar to ECF- so High in NaCl (130-154), lower in K (0-5), tend to be isotonic- these are resuscitation fluids
79
Describe the movement of replacement fluids
Meant to go to interstitial space
80
Name three replacement fluids
0.9% saline, NormosolR, plasmalyte A or 148, LRS
81
What are hypertonic fluids used for (function and indications)
Rapid intravascular volume expansion (hemorrhage), reduction of ICP in head trauma- DO NOT USE FOR RESUSCITATION
82
Describe the effects of hypertonic fluids
Short acting (15-20min) rapid pull of fluids from interstitial space into intravascular space causing 3-3.5x volume expansion per unit administered
83
How are hypertonic fluids administered
In short, 5-15 min boluses (may be repeated once) followed by isotonic/maintenance fluids to avoid electrolyte abnormalities and dehydration
84
Name three hypertonic fluids
3% or 7.5% saline, 20% mannitol
85
What are the other benefits of hypertonic saline
Decreased cerebral edema, increased cardiac contractility, possible anti-inflammatory effects
86
What are the disadvantages of hypertonic saline
hypernatremia, rapid admin (\>1mL/kg/min) can cause bradycardia, hypotension, bronchoconstriction
87
Indications for mannitol
Head trauma, acute glaucoma
88
Mannitol- adv and disadv
Adv: dec cerebral edema and blood viscosity, free radical scavenger; DisAd: can exacerbate edema, hemorrhage (esp in brain)
89
1 tsp = \_\_mL, 1 c= ____ mL
5, 236
90
What is the most important part of a fluid plan
Reassessment during treatment
91
What are colloids
Fluids with large insoluble molecules that wont cross membranes easily and hold water in vascular space for longer than crystalloids
92
What is the V of D of iso and hypertonic cystalloids
Initally to plasma then rapidly equillibrate (go more to intravasc (20%) and interstitial bc Na pumped out of cell)
93
What is the V of D of crystalloids
meant to have 100% V of D in intravascular space to maintain volume, but in vivo this is not fully the case
94
What value of the Starling Equation explains why very hypoproteinemic patients get limn edema but not pulmonary
Reflection coefficient- because this is the degree too which a membrane prevents transfer of colloid molecules-
95
How can colloid therapy be monitored
COP measured by colloid osmometer, measures the change in pressure; refractometer does not change above 4.5
96
How well does USG measure colloid administration
USG overestimated compared to urine osmolality with HES after 2-3 hours, usually correlate
97
What are the most important drugs in a crash cart
Atropine and epinephrine
98
What does the 10 second CPR assessment check for
Responsiveness, breathing/agonal breaths, pulses/heartsounds
99
What is the most important part of CPR
Compressions
100
What is the aim of CPR
Perfuse the brain and heart with oxygenated blood
101
What is the formula for cerebral perfusion pressure
MAP- ICP
102
What is the formula for coronary perfusion pressure
Aortic diastolic pressure - right atrial diastolic pressure
103
CPR breaths rate, depth, pressure
10-12 bpm, enough to make chest wall rise, no more than 20mmHg ((avoid pneumothorax)
104
Type of CPR- up to 15kg patient
Direct
105
Direct CPR- describe method, function
compression directly over heart, compression of heart chambers and artificial systole
106
Type of CPR for large dogs
Thoracic pump mechanism
107
Thoracic pump CPR- method, function
Compressions at deepest part of chest, complete relaxation between each- increase pressure in chest to force blood away from heart, relaxation allows blood to flow back towards thanks to one way valves
108
CPR compression rate
\>100bpm (100-120, faster not better)
109
Open chest CPR- method, approach
Technique to maximize flow via direct cardiac massage- cut right side between 5th and 6th rib space
110
Open chest CPR indications
Pneumothorax, pleural effusion, pericardial effusion, chest trauma, DOA, too large for external
111
When to stop CPR
return of pulse, spontaneous apex beat, sudden increase in CO2 output
112
Capnograph- what does 0-5 mean
Initial reading in arrested patient, 0 means ineffective chest compression
113
Capnograph- what reading indicates ROSC
Return of spontaneous circulation- 50-60, built up is leaving
114
What two ECG readings are indications for defibrillation
Ventricular fibrillation and pulseless ventricular fibrillation
115
Pulseless ventricular fibrillation
116
Ventricular fibrillation
117
Pulseless electrical activity- can look REGULAR, but has NO pulse!
118
Asystole
119
What is the most common EKG rhythm in vet med
Asystole
120
Which drugs cause constriction and increase arterial pressure
Vasopressors- epinephrine, vasopressin
121
Epinephrine administration
0.01 mg/kg @ 1mg/mL q 3-5 min during CPR- IV or endotracheally(double dose with saline flush and a large breath)
122
What can be used as a rescue medication if epinephrine fails during CPR, what other indications does it have
Vasopressin; helpful in severe acidosis or prolonged arrest
123
What is the effect of atropine, when should it be given
Reduce parasympathetic tone, first choice in bradycardia (and vagally mediated arrest)
124
Function of anti-arrhythmics besides arrhythmia correction; name two
Improve arterial BP; amiodorone, lidocaine
125
What contraindications are there for lidocaine
Cats and fibrillation (defibrillate first or it will reduce efficacy)
126
Amiodorone- indications, cautions
In V-fib after 2 unsuccessful defibrillations, possible anaphylaxis risk
127
What drug should only be used in severe pre-existing metabolic acidosis and hyperK arrests which arent responding to fluid therapy
Sodium bicarbonate- use with blood gas analysis
128
When should Calcium gluconate be used
HyperK cause of death or pre-existing hypoCa (like in eclampsia)- CONTRAINDICATED IN ALL OTHERS
129
What is the reversal for opioids
Naloxone
130
What is the reversal for benzos
Flumazenil
131
What is the reversal for alpha2agonists like xylazine and metomidine
atipamezole or yohimbine
132
What should be tried if defib is not successful
Amiodarone
133
What is the defib dose
2-4J/kg (4-6 in monophasic); increase by 50% on second try
134
Describe the flow of defib
shock- 2 min CPR - check ECG- increase dose 50%
135
What should be used if possible in open chest defib
Saline soaked gauze between heart and paddles
136
What is a possible effect of excess fluid therapy, explain
Overload goes to RA, increasing coronary pressure and _reducing cardiac perfusion_
137
What are some concerns for colloid therapy
Kidney damage and coagulopathy
138
What is a common post-resuscitation complication and how should it be treated
Myocardial dysfunction- pressors like dopamine or dobutamine (careful in cats); norepi can be added to dopamine
139
When to stop CPR
Assess q 3-5 min, avg stopping time 15-20 min, max 20-30 without improvement signs
140
What are the muscles of inspiration
Diaphragm, external intercostals, (in effort: scalene, nasal alae, and sternomastoids)
141
Muscles of expiration
Normal breathing elasticity of lung and chest wall recoil, but in effort- abdominal wall contraction increases intra-abd pressure to push diaphragm cranially
142
Define labored breathing
Engaging accessory inspiratory or expiratory muscles
143
Orthopnea
positional increases in difficulty- elbows abducted, head/neck extended
144
Ddx upper airway dz
LarPar, tracheal collapse, FB, cat polyps, BOAS
145
Ddz lower airway dz
asthma, chronic bronchitis, coughing/whezes
146
Tx for primary cardiac dz of respiratory parenchyma
Furosemide! (congenital, MVD, DCM, HCM, RA enlargement)
147
Tx non-cardiac respiratory parenchyma dz
Bronchodilators (Hx of V, anesthesia, coughing)
148
How can cardiac and non-cardiac respiratory parenchymal dz be differentiated
Rads-
Cardiac- LA backpack, PA/V enlargement, lung patterns
149
What are the three most important things in respiratory distress
Hands off- oxygen- sedate when needed
150
Indications and Rx for sedated airway exam
Upper airway: stridor, obstruction, BOAS; sedate to effect with propofol (dont knock out), avoid acepromazine and opiates (decrease laryngeal and cough fxn)
151
Sedated airway exam: what to check
Larynx for arytenoid fxn; tissues surrounding for saccules, elongation; oral masses; inflammation of proximal trachea
152
Upper airway dz- exam ddx
SCC (cat larynx), LarPar polyneuropathy (L side), lymphoma (looks like edema, not mass)
153
What Rx can be given to increase breathing and show arytenoid movement
Doxapram
154
Thoracocentesis- approach
8th or 9th intercostal space, avoid caudal edge of ribs for vessels and nerves; Fluid- bottom third; Air- top third- 16g catheter through nick in skin from scalpel
Can also do over the wire or surgical approach
155
Nasal oxygen- tube type, drugs needed, approach
Measure from end of nose to medial canthus8-14 Fr, wider tube causes less pressure/irritation; tetracine local drops in nostril; ventromedial approach
156
Technique: temporary tracheostomy
Inscise skin and SQ longitudinally in the midline (patient must be straight), separate strap muscles, go 2-3 rings below larynx, incise horizontally less than 1/3 circumferance, use stay sutures labeled up and down to open hole later when changing tube
157
Stages of labor: 1
12-24 h, restlessness, queens dig/bitches quiet, temp drop to 98F
158
Stages of labor: 2
6-12h, temp normal, see uterine contraction, fetal expulsion
159
Stages of labor: 3
Immediately after stage 2- placental expulsion
160
Signs of dystocia
Stage 2 \> 12h, Weak contractions for 2-3 h, strong contractions with no expulsion in 1h, \>3 hours between deliveries, temp drop and no birth in 24-36h, fetal HR \<160
161
Fetal causes of dystocia (5)
Monster, oversize, singleon, improper presentation, death
162
Maternal causes of dystocia (5)
Uterine inertia, abdominal hernias, pelvic stenoses, uterine/vaginal trauma, hydrops
163
Primary uterine intertia
contractions never were going to happen, oxytocin wont help
164
Secondary uterine intertia
so exhausted uterus gives up
165
Why does singleton cause dystocia
Not enough to send hormonal signals to start uterine inertia or sustain
166
Breeds susceptible to fetal oversize and singleton
persian, himalayans, bulldogs
167
Describe hydrops
Golden retriever with cankles/edematous vulva, excess fluid in amniotic sac occluding CaVC- caudal and ventral edema
168
Causes of uterine inertia
Hormonal- abnormalities of cascade (est, progest, relax, prolactin, PGs)
Metabolic- hypoGly, hypoCa
Myometrial- single pup, age, overstretch
Anatomic- cervix/vagina/vulva- immaturity, under-dilated, dz, abnormal, etc
Psychologic
169
Dx dystocia
Fetal HR \<160 is best (also PE, rads, U/S, acid/base, etc)
170
Rx for metabolic uterine inertia
Oxytocin
171
When can medical tx be used to dystocia
Only when not obstructed, healthy, failure to progress, contractions present, no oversize
172
First Rx, medical dystocia tx
Calcium- 10% CaGluconate to increase strength of contractions
173
Secondary Rx for medical dystocia tx
Oxytocin- to increase freq of contractions
174
Indications for Sx tx of dystocia
obstruction, stressed/dead, oversize, sick mom, failed medical tx
175
Sx tx of dystocia, Rx used
Balanced electrolytes throughout all, pre-oxygenate ebfore anesthesia, propofol induction, iso maintenance, lidocaine block
176
Sx approach- C-section
Ventral midline incision, extrude uterus, the three options:
take out, put back in
Take out, OHE
En Bloc- OHE then remove fetus (MUST BE FAST)
177
Dystocia surgical emergencies
uterine torsion, uterine rupture
178
Neonate resuscitation
Remove fetal membranes, suction mouth/nose, clamp umb 1/4" from body (suture, betadine, dry), DV with head extended, stimulation of respiration, thermal support with 60% humidity
If none after 35-40 sec, GV26 acupuncture point at nasal filtrum and doxapram sublingual
179
Indications for maternal Abx after birth
Rupture, torsion, fetal fluid contamination of abdomen
180
Cause of pregnancy toxemia, CS
Nutritional related ketosis and negative energy balance late in prenancy from lack of carbs; weakness, lethargy, seizures, hyporexia
181
Dx pregnancy toxemia
ketosis with glucosuria
182
1-4 weeks after whelping, face rubbing, anorexia, hyperthermia, tremor, seizure
Eclampsia
183
Dx eclampsia
iCa- \<1.4 mmol\>L
or
tCa \<6.5 dog or \<6 cat
184
Tx eclampsia
CaGluconate IV over 10-15 min,
185
When does pyometra occur
During diestrus due to high progesterone in middle to older aged
186
Tx pyometra
Dont let the sun set- IV fluids, OHE, IV Abx
187
What causes vaginal hyperplasia
Estrogen influence
188
Tx vaginal hyperplasia
lubricate and protect if no necrosis, wait til follicular phase pases and will resolve; Sx if mucosal damage or too large
189
Mastitis- causes, dx, tx
e. coli or staph; milk cytology/culture, cidal abx, lance/drain
190
Causes of testicular abscess
trauma, brucellosis
191
Paraphimosis
Penis stuck out, not erect
192
Priapism
Erect penis stuck out
193
Tx paraphimosis or priapism
sedation/anesthesia, no drugs with peripheral vasodilation, lubrication or hypertonic soak
194
Top causes of blocked cat
uroliths and FIC (cells/mucus/cystal plugs)
195
What kills blocked cat
HyperK, hypovolemia, metabolic acidosis
196
Tx blocked cat- stable
Bolus LRS or 0.9 saline, sedation, catheter
197
Dx, tx sick blocked cat
K \>8, sine wave or absent P wave on ECG; Fluid resuscitation to tx hyperkalemia before unblocking,
198
Lowering K in blocked cat
Ca gluconate- changes threshold to restore gradient
Insulin/NaBicarb/terbutaline to send K intracellularly
199
Sedation options for blocked cat (without ET, with ET, sick
without ET- ket, midazolam, buprenorphine
With ET- propofol
Sick: sacro-coccygeal blck or buprenorphine
200
Unblocking procedure
Open ended tom cat catheter, extrude penis then pull prepuce over catheter to straighten S shape, flush while passing if resistance, gently twist while applying gentle pressure to bladder, empty bladder, replace with red rubber tube, suture to skin
201
Post-unblock tx
Buprenorphine q6-8, monitor urine output q1-2, copious fluids to deal with possible post-obstructive diuresis- WATCH OUT FOR HYPOKalemia
202
Causes of post-obstructive diuresis
medullary washout, osmotic diuresis, pressure necrosis, ADH resistance
203
When is blocked cat surgical
Repeats, stones, cant unblock
204
Why not PU right away?
205
