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NCERT ECC IMPROVE INTERNATIONAL > Fluid Therapy in the Emergency Patient > Flashcards

Fluid Therapy in the Emergency Patient Flashcards

1
Q

What is dehydration

A

Dehydration refers to the deficit where water is lost over the whole body.

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2
Q

What type of fluid is normally lost in a dehydrated patient

A

Normally intercellular or interstitial fluid.

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3
Q

What is the best treatment for dehydration?

A

IVFT - isotonic crystalloids (Hartmanns)

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4
Q

How do you calculate a treatment plan for a patient that is dehydrated?

A
  1. Calculate replacement of deficit
  2. Calculate maintenance
  3. Calculate ongoing losses
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5
Q

How do you calculate replacement deficit in a dehydrated patient?

A

(mL) = BWT in kg x % of dehydration x 10

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6
Q

How do you calculate the maintenance fluid rate of a patient?

A

60 ml/kg/day cats and small breeds
50 ml/kg/day medium breeds
40 ml/kg/day large breeds

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7
Q

How do you calculate ongoing losses in a dehydrated patient

A

monitor and measure any vomiting/diarrhoea over 24 hours

measure urine out put and any fluid produced from a drain.

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8
Q

What is the average water content of an adult animal?

A

60% of their body weight

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9
Q

how much of the body water content is intracellular fluid?

A

40% (2/3)

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10
Q

how much of the body water content is extracellular?

A

20% (1/3)

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11
Q

how much of the body water content is interstitial fluid

A

15% of bodyweight

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12
Q

What are the 4 questions asked when making a fluid plan?

A
  1. Does the patient need fluid therapy?
  2. Which route should it be administered?
  3. Which fluid should be administered?
  4. What rate should the fluid be administered?
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13
Q

What is hypovolemia

A

Refers to a reduction of intravascular volume. Which reduces perfusion to the tissues causing a perfusion deficit.

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14
Q

What is the treatment of hypovolemia

A

Bolus fluid therapy

Normally isotonic crystalloids but hypertonic crystalloids, colloids and blood products can be used too.

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15
Q

What is suggest bolus rate for a dog who have presented severely hypovolemic

A

60-90ml/kg

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16
Q

What is suggest bolus rate for a dog who have presented mildly hypovolemic

A

10-20ml/kg

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17
Q

What is suggest bolus rate for a dog who have presented moderately hypovolemic

A

30-50ml/kg

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18
Q

What is suggest bolus rate for a cat who have presented severely hypovolemic

A

40-60ml/kg

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19
Q

What is suggest bolus rate for a cat who have presented moderately hypovolemic

A

10-20ml/kg

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20
Q

What is suggest bolus rate for a cat who have presented mildly hypovolemic

A

5-7 ml/kg

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21
Q

How long should you administer a fluid bolus?

A

15 - 60 mins depending on severity.

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22
Q

Where does sodium live in the cells

A

extracellularly

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23
Q

What will an increase or decrease of sodium be a reflection of?

A

The water balance in the patient

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24
Q

What are 7 clinical signs of hyponatraemia?

A 
Vomiting 
abdominal pain
 seizures 
weakness 
hypotension 
Anorexia 
Shock
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25
What is the best treatment for hyponatraemia?
0.9% saline IVFT
26
What anion represents 2/3 of the bodies anions in the blood?
Chloride
27
What are some causes of hypochloraemia?
Gastric Vomiting Duodenal FB Pancreatitis Administration of diuretics
28
What is the treatment for both hypo and hyperchloraemia?
0.9% Nacl
29
Where does Potassium live in the cells
Intracellular
30
Where is potassium absorbed
GI tract
31
What can happen is the concertation of potassium is altered??
The electrical potential across the cell membrane can change which leads to cellular and organ dysfunction
32
What are 4 causes of hypokalaemia
Vomiting/Diarrhoea Renal disease polyuria
33
What are 4 causes of hyperkalaemia
Renal failure Urethral obstruction Addison disease Acidosis
34
What is the treatment for hypokalaemia
IVFT supplementation
35
What is the treatment for hyperkalaemia
Insulin (followed by glucose) Calcium Gluconate Sodium Bicarbonate
36
What are the 3 form magnesium lives in the body
In the heart (1%) In the skeletal muscle (19%) As protein bounds (phosphate, sulphate)
37
What are clinical signs of hypomagnesaemia?
Diarrhoea | Neuromuscular signs - twitching, seizures
38
What is the treatment for hypomagnesaemia?
magnesium supplementation in 5% dextrose
39
What is the treatment for hypermagnesaemia?
0.9% Nacl LRS Frusemide
40
What is the most common cause for hypercalcaemia?
Neoplasia
41
What is an electrolyte
An electrolyte is a mineral that carries an electric charge when dissolved
42
What is the function of a blood electrolyte
They help regulate nerve and muscle function and maintain acid base and water imbalance
43
What is osmosis?
The movement of fluid from an area of low concertation to an area of high concertation
44
What part of the body maintains electrolyte concentrations?
Kidneys
45
How do kidneys maintain electrolyte concerntrations?
By filtering electrolytes and water from the blood, and excreting urine
46
What is homeostasis
Homeostasis is a healthy state that is maintained by the constant adjustment of biochemical and physiological pathways.
47
What is an isotonic crystalloid?
A solution that can easily leave the intravascular fluid and enter all body compartments.
48
When are isotonic crystalloids best used?
Hypovolemia and dehydration
49
What are some examples of isotonic crystalloids
Hartmanns, LRS 0.9% NaCl
50
What is an hypertonic crystalloid?
A fluid that has 8x the osmolarity of plasma.
51
What happens when hypertonic crystalloids are administered in the intravascular space
The fluid from the interstitial space is brought into circulation
52
What is an example of a hypertonic crystalloid is used
A patient with intracranial pressure
53
What is an example of a hypertonic crystalloid
7.2% saline
54
Why are hypotonic crystalloids poor for replacing intravascular volume?
Poor volume expanders and dilute serum electrolytes
55
What is an example for a hypotonic crystalloid?
0.18% NaCl | Dextrose 4% 5%
56
What happens in the blood when dextrose is administered
Dextrose is metabolised in the blood stream immediately and the water left is isotonic.
57
What are hypotonic crystalloids used for
dehydration and no signs of lack of perfusion
58
Why are synthetic colloids are more efficient at maintain intravascular volume?
Because they are large molecules that don't equilibrate across the membrane and remain in the intravascular space.
59
What are 3 examples of a synthetic colloid
Gelatin (Gelfusine) Dextrans (dextran 40 or 70) Hyrdoxyethyl starches
60
What is the most common type of shock
hypovolaemic shock
61
What happens to the vessels in hypovolaemic shock
Vasoconstrict
62
Why does hypoperfusion occur in hypovolaemic shock
Lack of circulating volume
63
What are the clinical signs of hypovolaemic shock?
increased heart rate (compensatory response) poor pulse quality ( vasoconstriction) pale mucous membranes (lack of circulating volume and lack of o2 ) unconscious (brain takes a lot of energy and glucose) prolonged CRT (hypoperfusion) High lactate Cold extremities vs core temp
64
What is maldistributive shock
maldistributive shock where intravascular fluid is being abnormally distributed across the body. due to the poor perfusion of tissues and lack of vasomotor tone lead to inappropriate vasodilation.
65
What are the clinical signs of maldistributive shock
``` High heart rate Red mucous membrane quick CRT Leaky vessels Reduced venous return and cardiac output ```
66
A decreased in circulating blood volume can lead to what type of shock?
hypovolaemic
67
A decrease in ability of the heart to pump blood can lead to what type of shock?
cardiogenic
68
A decrease in ability of the vascular system to maintain vasomotor tone can lead to what type of shock?
maldistributive shock
69
An obstruction of blood flor from or to the heart can lead to what type of shock?
Obstructive shock
70
What is an example of maldistributive shock
SIRS
71
What is an example of Obstructive shock
GDV
72
What are some clinical signs of Distributive shock
Vasodilation red MM leaky vessels reduced venous return and cardiac output
73
What is the dose for a plasma transfusion
20ml/kg
74
How many mLs of PRBC's will increase a PCV by 1%
1ml
75
How many mLs of whole blood will increase a PCV by 1%
2ml
76
What is the formula to calculate how much blood is needed for a transfusion in (mL)
target pcv - actual pcv = increase required how many mls/ % x increase required x body weight OR (tartget PCV - actual PCV) / donors PCV x BWT x (N) N = dogs 90 cats 60
77
What are the two dog blood types
DEA positive or DEA negative
78
What are the cat blood groups
A, B and AB
79
Is AB blood is unavailable what is best to transfuse
A

NCERT ECC IMPROVE INTERNATIONAL (8 decks)

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