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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
Q

What is the best treatment for hyponatraemia?

A

0.9% saline IVFT

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26
Q

What anion represents 2/3 of the bodies anions in the blood?

A

Chloride

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27
Q

What are some causes of hypochloraemia?

A

Gastric Vomiting
Duodenal FB
Pancreatitis
Administration of diuretics

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28
Q

What is the treatment for both hypo and hyperchloraemia?

A

0.9% Nacl

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29
Q

Where does Potassium live in the cells

A

Intracellular

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30
Q

Where is potassium absorbed

A

GI tract

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31
Q

What can happen is the concertation of potassium is altered??

A

The electrical potential across the cell membrane can change which leads to cellular and organ dysfunction

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32
Q

What are 4 causes of hypokalaemia

A

Vomiting/Diarrhoea
Renal disease
polyuria

33
Q

What are 4 causes of hyperkalaemia

A

Renal failure
Urethral obstruction
Addison disease
Acidosis

34
Q

What is the treatment for hypokalaemia

A

IVFT supplementation

35
Q

What is the treatment for hyperkalaemia

A

Insulin (followed by glucose)
Calcium Gluconate
Sodium Bicarbonate

36
Q

What are the 3 form magnesium lives in the body

A

In the heart (1%)
In the skeletal muscle (19%)
As protein bounds (phosphate, sulphate)

37
Q

What are clinical signs of hypomagnesaemia?

A

Diarrhoea

Neuromuscular signs - twitching, seizures

38
Q

What is the treatment for hypomagnesaemia?

A

magnesium supplementation in 5% dextrose

39
Q

What is the treatment for hypermagnesaemia?

A

0.9% Nacl
LRS
Frusemide

40
Q

What is the most common cause for hypercalcaemia?

A

Neoplasia

41
Q

What is an electrolyte

A

An electrolyte is a mineral that carries an electric charge when dissolved

42
Q

What is the function of a blood electrolyte

A

They help regulate nerve and muscle function and maintain acid base and water imbalance

43
Q

What is osmosis?

A

The movement of fluid from an area of low concertation to an area of high concertation

44
Q

What part of the body maintains electrolyte concentrations?

A

Kidneys

45
Q

How do kidneys maintain electrolyte concerntrations?

A

By filtering electrolytes and water from the blood, and excreting urine

46
Q

What is homeostasis

A

Homeostasis is a healthy state that is maintained by the constant adjustment of biochemical and physiological pathways.

47
Q

What is an isotonic crystalloid?

A

A solution that can easily leave the intravascular fluid and enter all body compartments.

48
Q

When are isotonic crystalloids best used?

A

Hypovolemia and dehydration

49
Q

What are some examples of isotonic crystalloids

A

Hartmanns, LRS 0.9% NaCl

50
Q

What is an hypertonic crystalloid?

A

A fluid that has 8x the osmolarity of plasma.

51
Q

What happens when hypertonic crystalloids are administered in the intravascular space

A

The fluid from the interstitial space is brought into circulation

52
Q

What is an example of a hypertonic crystalloid is used

A

A patient with intracranial pressure

53
Q

What is an example of a hypertonic crystalloid

A

7.2% saline

54
Q

Why are hypotonic crystalloids poor for replacing intravascular volume?

A

Poor volume expanders and dilute serum electrolytes

55
Q

What is an example for a hypotonic crystalloid?

A

0.18% NaCl

Dextrose 4% 5%

56
Q

What happens in the blood when dextrose is administered

A

Dextrose is metabolised in the blood stream immediately and the water left is isotonic.

57
Q

What are hypotonic crystalloids used for

A

dehydration and no signs of lack of perfusion

58
Q

Why are synthetic colloids are more efficient at maintain intravascular volume?

A

Because they are large molecules that don’t equilibrate across the membrane and remain in the intravascular space.

59
Q

What are 3 examples of a synthetic colloid

A

Gelatin (Gelfusine)
Dextrans (dextran 40 or 70)
Hyrdoxyethyl starches

60
Q

What is the most common type of shock

A

hypovolaemic shock

61
Q

What happens to the vessels in hypovolaemic shock

A

Vasoconstrict

62
Q

Why does hypoperfusion occur in hypovolaemic shock

A

Lack of circulating volume

63
Q

What are the clinical signs of hypovolaemic shock?

A

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
Q

What is maldistributive shock

A

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
Q

What are the clinical signs of maldistributive shock

A 
High heart rate 
Red mucous membrane 
quick CRT 
Leaky vessels 
Reduced venous return and cardiac output
66
Q

A decreased in circulating blood volume can lead to what type of shock?

A

hypovolaemic

67
Q

A decrease in ability of the heart to pump blood can lead to what type of shock?

A

cardiogenic

68
Q

A decrease in ability of the vascular system to maintain vasomotor tone can lead to what type of shock?

A

maldistributive shock

69
Q

An obstruction of blood flor from or to the heart can lead to what type of shock?

A

Obstructive shock

70
Q

What is an example of maldistributive shock

A

SIRS

71
Q

What is an example of Obstructive shock

A

GDV

72
Q

What are some clinical signs of Distributive shock

A

Vasodilation
red MM
leaky vessels
reduced venous return and cardiac output

73
Q

What is the dose for a plasma transfusion

A

20ml/kg

74
Q

How many mLs of PRBC’s will increase a PCV by 1%

A

1ml

75
Q

How many mLs of whole blood will increase a PCV by 1%

A

2ml

76
Q

What is the formula to calculate how much blood is needed for a transfusion in (mL)

A

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
Q

What are the two dog blood types

A

DEA positive or DEA negative

78
Q

What are the cat blood groups

A

A, B and AB

79
Q

Is AB blood is unavailable what is best to transfuse

A

A

NCERT ECC IMPROVE INTERNATIONAL (8 decks)

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