finale Flashcards
Shock
Inadequate cellular energy production caused either by poor oxygen delivery or increased cellular oxygen consumption.
Decreased oxygen delivery (DO2)
Diminished tissue perfusion
Increased oxygen consumption (VO2)
Increased cellular metabolism (heat stroke, sepsis, seizures/ tremors, etc.)
Why does energy production decrease?
No O2 = shift to anaerobic metabolism.
Determinants of DO2?
Cardiac output (HR+SV) x CaO2 (Hgb,SaO2,PaO2)
Shock Classifications
know about each – causes and clinical examples
Cardiogenic Hypovolemic Obstructive Distributive/ Vasogenic (“Call Help or Die”)
Shock Stages
know about each – clinical signs and outcome
Compensatory
Early Decompensatory
Decompensatory (Terminal)
How do Cats Differ?
Bradycardia, hypothermia, hypoglycemia, hypotension. Smaller blood volume than dogs.
Overall approach to shock?
Must identify and treat the underlying cause, and support patient to treat or prevent SIRS/ other complications.
Where are the following useful for shock treatment? Pressors Chronotropes Fluids Vasodilators Contractility RBC Transfusion Oxygen therapy
Pressors – Increase SVR Chronotropes – Increase heart rate Fluids – Increase preload Vasodilators – Reduce afterload Contractility – Increase strength of contraction RBC Transfusion – Increase hemoglobin Oxygen therapy – Increase dissolved O2
List monitoring parameters for shock (in order of clinical applicability)
Mentation MM color CRT Heart rate Pulse quality Blood pressure Urine output CVP Acid-base
Upper limits for shock dose of crystalloid and colloid? Know indications for each, and how to adjust if crystalloid and colloid are both used?
Crystalloid: Dogs 80-90 ml/kg, cats 50-60 ml/kg Colloid: Up to 20 ml/kg Administer ~25% of dose, reevaluate to treat to end points Hypertonic Saline: 4 ml/kg
Major drugs for inotropic and pressor support?
Dobutamine – Inotrope
Dopamine – Inotrope (lower dose) or pressor (higher dose)
Both given IV CRI
Define Systemic Inflammatory Response (SIRS)
A local problem causing systemic inflammation (infectious and non-infectious causes – be able to provide examples). Essentially, an overreaction to inflammation.
What are the major cytokines in SIRS?
IL1, IL6, IL8, TNF-alpha, Platelet activating factor
How is multiple organ dysfunction caused?
Animal with SIRS has damage to vascular endothelium from activation of coagulation, complement pathways, PGs and LTs
Which are the target cells for SIRS
WBC, Platelets, Endothelial cells
Define multiple organ dysfunction syndrome (MODS)
Severe, acquired dysfunction of 2 or more organ systems for > 24-48 hours not due to primary illness
What are SIRS criteria
Hyperthermia or hypothermia Tachycardia Tachypnea Respiratory alkalosis (low PaCO2) Leukocytosis or leukopenia, left shift
SIRS treatment?
Antibiotics
Gastric protectants and nutrition (to avoid gastric barrier breakdown)
Positive pressure ventilation (ARDS)
Anticipate and avoid complications
Critically ill – require 24-hour care facility and monitoring
Zoonosis vs. Anthropozoonosis
Zoonosis: Found in animals, transmissible to people
Anthropozoonosis: Found in people, transmissible to animals
Methcillin-resistant Staph aureus (MRSA)
One member of a group of bacteria which are highly resistant to common classes of antibiotics. Also includes MRSPseudintermedius. Zoonotic and anthropozoonotic. Therefore, infection can be harbored and cause re-infection.
Biosecurity
Active steps to prevent introduction of hazardous threats (biological, chemical, etc.) into an environment.
Identify 2 sources discussed in class of free, online resources available to veterinarians to develop sound infection control practices
National Association of State Public Health Veterinarians website (Model infection control document) and Canadian Committee on Antimicrobial Resistance (Infection Prevention and Control Best Practices document)
Identify and describe 3 levels of infection control in an infection control plan
Engineering controls: Physical facility design to facilitate hygiene/ prevent human error
Administrative controls: Written policies/ procedures developed to address various aspects of infection control
Personal protective equipment: Contains, but does not eliminate, a hazard
What is the role of the Infection Control Practitioner?
Addresses all aspects of the infection control plan, alters the plan to address changes in infection landscape, and enforces adherence to institutional policy.
In a 2008 survey of veterinarians, what risk was identified for respondents without a written infection control policy (ICP)?
Lack of a written ICP = poor infection control practice.
What is the single most important infection prevention tool?
Appropriate hand hygiene (hand washing, alcohol-based hand sanitizer use)
What is the cardinal rule of disinfection?
Organic matter must be cleaned from the environment before disinfection can work.
What is a nosocomial infection?
Infection that is not present or incubating at the time of admission to a healthcare facility
What is the difference between active and passive surveillance?
Passive surveillance: Ongoing assessment tool to identify nosocomial populations and detect serious threats by reviewing medically indicated test results.
Active surveillance: Proactive protocol of performing testing to identify specific bacterial threats or evaluate hygiene programs
Tentorium herniation
Loss brain fn progression
Ro➡️Ca: CPPDR
Consciousness Posture/tone Pupils Dolls eye Respiration
Stage tentorium herniation
DMPM
Dienceph
Midbrain: 👀 CN 3
Pons: 🚫 dolls eye
Medulla ➡️ foramen magnum ☠️
Head trauma tx
🚫 GCC
✅sedate: ace/opiates/diazepam
✅hypertonic saline
✅mannitol
