Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Small Animal Medicine II > Fluid Therapy & Shock > Flashcards

Fluid Therapy & Shock Flashcards

1
Q

Examples of Synthetic Colloid Solutions

A

VetStarch

Hetastarch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a Colloid Solution (Properties)

A

Contains large molecular substances which do not readily cross capillary membranes => remains in the intravascular space

Increases colloid oncotic pressure; draws water into IV space (helps with hypoproteinemia cases)

Increases total blood volume

Long lasting effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Shock bolus (Isotonic)
Canine
Feline

A

Canine: 90 mL/kg

Feline: 40-60 mL/kg

Comes from blood volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Maintenance rate
Canine
Feline

A

Canine: 60 mL/kg/day

Feline: 50 mL/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Examples of Natural Colloid Solutions

A

Plasma

Albumin (only human and canine available)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Examples of Oxygen Carrying Colloid Solutions

A

Whole blood

PRBCs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Synthetic Colloids: effect on IV volume

A

Will increase IV volume by more than the volume infused

Example: give I L VetStarch, IV space will pull 370 mL fluid from interstitial space
IV space volume: 1,370 mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why use Colloids?

A

Improve intravascular volume (treat hypovolemia and/or hypotension)

Maintain intravascular colloid oncotic pressure (usually due to hypoproteinemia) – minimize tissue edema

Do NOT give in a dehydrated patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

VetStarch and Hetastarch:

Physiochemical properties-structure

A

Hydroxyethyl Starch; similar to glycogen (less likely to have adverse reaction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

VetStarch and Hetastarch:

Elimination half-life determined by:

A

Molar substitution (how many hydroxyl groups are replaced by hydroxyethyl groups)

Substitution C2:C6 ratio (higher the ratio the longer the molecule stays in IV space)

Molecular weight (larger the molecule the longer it stays in the IV space)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Hydroxyehtyl Starch Solutions:

Adverse effect

A

Coagulopathy
Depends on:
Molecular weight
Molar substitution (how many hydroxyl groups have been substituted with hydroxyethyl groups; the more substitutions the more likely patient will become hypocoaguable)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hetastarch (HES 450/0.7)

Properties

A

Mean MW: 450 kDa
Molar Substitution: 0.7 (70% substituted with hydroxyethyl group)
C2:C6 ratio 5:1
Volume Expansion: >100%
Duration: 24-36 hours (even with a bolus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hetastarch (HES 450/0.7)

Side Effects

A

Allergic reactions (vomiting)

Coagulopathies:
Dilutes clotting factors
Inhibits platelet function (less sticky)
Decrease fibrin clot stabilization
Decrease activity of factor VIII & vonWill factor
Accelerates fibrinolysis
Clot may form but is weak

Potentially renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What part of the coagulation cascade is factor VIII & vonWill a part of?

A

Intrinsic pathway: APTT

Hetastarch will elevate APTT (slight is okay)

When APTT increases 1.5-2x then more likely to hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hetastarch (HES 450/0.7)

Recommended dosage

A

Canine: 20 mL/kg/day

Feline: 10-20 mL/kg/day

Can always be less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hetastarch (HES 450/0.7)

Administration

A

Bolus (shock)
Canine: 5 mL/kg
Feline: 2.5-5 mL/kg

CRI (in hypoproteinemia cases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

VetStarch (HES 130/0.4)

Properties

A

Mean MW: 130 kDa
Molar Substitution: 0.4 (40% substituted with hydroxyethyl group)
C2:C6 ratio 9:1 (high; if lower than would get eliminated quickly)
Volume expansion: >100%
Duration: 4-6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

VetStarch (HES 130/0.4)

Side Effects

A

Allergic reactions

Coagulopathies (less likely than Hetastarch)
Dilution of clotting factors
Less effect on factor VIII and vonWill factor

Renal failure less likely due to smaller MW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

VetStarch (HES 130/0.4)

Recommended dosage

A

Canine: 20-50 mL/kg/day

Feline: 10-20 mL/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

VetStarch (HES 130/0.4)

Administration

A

Bolus (shock)
Canine: 5 mL/kg
Feline: 2.5-5 mL/kg

CRI (24 hour)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Plasma

What is it?

A

Obatained after RBCs have been removed from whole blood

Provides:
Protein (albumin, globulin, fibrinogen)
Coagulation factors and antithrombin
Immunoglobulins (may be helpful in immunocompromised patients; parvo and panleuk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Plasma

Disease sate that contraindicates

A

IMHA
Patients are anemic however blood volume is normal
Safer to administer RBCs otherwise make them hypercoaguable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Plasma

Properties

A

MW: 66 to 60 kDa

Oncotic properties:
Increases plasma volume by the volume administered (no pull of extra fluid into IV space)

Carrier for hormones, enzymes, drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Why use plasma?

A 
DIC
Vitamin K deficiency
Congenital clotting factor deficiency
Coagulation disorders from liver disease
Immunodeficiency syndromes 
Low total protein (<4.0 gm/dL)

Does NOT help with hypoalbuminemia (do so through nutrition)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Plasma

Recommended dosage

A

10-20 mL/kg

10 mL/kg: increase coagulation factors by 20%

20 mL/kg will increase total protein by 1 g/dL

Note: the higher the PT and APTT the more plasma needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

If a patient needs platelets what should be administered?

A

Fresh whole blood for greatest improvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Plasma

Side Effects

A

Allergic/hypersensitivity (Type and Cross-Match)

Fluid overload

Infectious diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Packed Red Blood Cells
Administration
Dosage

A

Administration:
Give in anemic patients with normal protein concentrations and coagulation status

Dosage:
1.5 mL/kg of PRBCs will raise PCV by 1%

Note: do NOT have to raise the PCV to 45% should be <25% to decrease clincal signs of anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How much will the PCV increase in a 30 kg dog given 1 unit of PRBCs (255 mL)

A

5%

1.5 mL/kg * 30 kg = 45 mL
255 mL/ 45 mL = 5.6666

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Fresh or Stored Whole Blood
When to use it
Dosage

A

When to use it:
Anemia with hypoproteinemia and/or coagulopathy (factor or platelet deficiency)

Dosage:
2.2 mL/kg of whole blood raises the PCV by 1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is hypovolemic shock?

A

Most common!

Inadequate circulating blood volume; overall fluid loss

Patients have systemic vasodilation
Does not respond to intrinsic catacholamines (trying to cause vasoconstriction)

32
Q

What is distributive shock?

A

Maldistribution of blood flow and volume; inappropriate vasodilation, relative hypovolemia

Increased vessel permeability

Decreased CO due to cytokines

Activation of coagulation system

33
Q

What is obstructive shock?

A

Extracardiac obstruction of blood flow; low CO

Need to increase cardiac output

34
Q

What is cardiogenic shock?

A

Primary pump failure (often have bradycardia); decreased CO

Do NOT administer fluids
Exception: cardiac tamponade; more of an obstructive shock, pericardial sack is filled with fluid (right sided issue; give fluids to help fill R ventricle)

35
Q

Clinical Signs of Shock

A 
Hypotension
Tachycardia
Poor pulse quality
Prolonged CRT
Pale mucous membranes
Hypothermia 
Tachypnea
36
Q

What type of fluids do you avoid giving to a patient in shock?

A

Hypotonic crystalloids; does not support IV expansion

37
Q

What increases microvascular permeability?

A

Immune mediated diseases
Sepsis
Vasculitis
Anaphylaxsis

38
Q

When should you administer colloids over crystalloids in a shock patient?

A

Hypovolemic, Distributive, or Obstructive shock

Increased microvascular permeability

Decreased COP

39
Q

When should you administer crystalloids and colloids to a shock patient?

A

Hypovolemic, Distributive, or Obstructive shock

Increased microvascular permeability with normal COP

Normal microvascular permeability with decreased COP

40
Q

Three main things to consider when treating a hemorrhage shock patient

A
  1. External? Internal?
  2. Fluid therapy: aggressive in external hemorrhage patients, volume-limited in internal hemorrhage pateints
  3. Values:
    External; achieve normal
    Internal; achieve subnormal
41
Q

Internal hemorrhage patients approach (management)

A

Stabilize

Best to medically manage these patients, may not require surgery at all

Values:
BP: do NOT exceed 100 mmHg
Produce urine
Lactate normalize

42
Q

Nontraumatic Hypovolemic Shock Fluid Deficit

A

Intravascular (Interstitial/Intracellular)

43
Q

Nontraumatic Hypovolemic Shock Pathophysiology

A

Decreased blood volume with concurrent dehydration

44
Q

Nontraumatic Hypovolemic Shock Microvascular Permeability

A

Normal

45
Q

Nontraumatic Hypovolemic Shock Plasma Oncotic Pressure

A

Normal

46
Q

Isotonic crystalloids
What do they do (2 things)
1 Adverse response

A

Expand IV compartment
Rehydrate the ISF compartment

Adverse response:
May worsen interstitial edema or third space loss

47
Q

Traumatic Hypovolemic Shock Fluid Deficit

A

Intravascular

48
Q

Traumatic Hypovolemic Shock Pathophysiology

A

Decrease blood volume

49
Q

Traumatic Hypovolemic Shock Microvascular Permeability

A

Normal to increased

Increased: use colloids (b/c of large MW)

50
Q

Traumatic Hypovolemic Shock Plasma Oncotic Pressure

A

Normal to decreased

Decreased: use colloids

51
Q

When would you use hypertonic crystalloids?

A

Traumatic hypovolemic shock potentially

Augments IV compartment

Beneficial in treating head trauma by reducing ICP

52
Q

Septic Shock

Fluid Deficit

A

IV (relative depletion)

53
Q

Septic Shock

Pathophysiology

A

Maldistribution of blood flow

54
Q

Septic Shock

Microvascular Permeability

A

Increases

55
Q

Septic Shock

Plasma Oncotic Pressure

A

Decreases

56
Q

What is shock?

Main goal of treatment?

A

Shock is the inadequate delivery of oxygen to your tissues

Main goal: improve patient’s perfusion

57
Q

Can a patient be in shock and have normal blood pressure?

A

Yes

58
Q

Compensated Shock

A

Tachycardia with poor perfusion

Patient compensates for low cardiac output with tachycardia and increase in systemic vascular resistance

59
Q

Decompensated Shock

A

Frank hypotension

Early organ dysfunction changes

Azotemia, oliguria/anuria, hyperbilirubinemia, and DIC

Difficult to bounce back from

60
Q

Compensatory Shock in the Dog

A

Manifest as hyperdynamic and hypermetabolic response (brick red mucous membranes)

Tachycardia, tachypnea, hyperemia, decreased CRT and pyrexia

61
Q

Compensatory Shock in the Cat

A

Often already headed to decompensated shock

Lethargic, bradycardic, hypothermic, hypotensive, pale mm, weak pulses

62
Q

Cardiogenic Shock: Causes

A 
Pump failure (CHF)
Arrhythmias 
Decreased contractility (DCM) 
Ventricular outflow obstruction (SAS) 
Acute valvular failure (endocardiosis)
63
Q

Cardiogenic Shock:

Pathophysiology

A

Body wants to regulate BP (maintain perfusion)

Systolic/diastolic dysfunction (increase HR, decrease SV and therefore CO)

Decrease perfusion to tissues (decreased BP and increased peripheral vascular resistance) - compensatory systems max out

Pulmonary edema; increased pulmonary venous pressure

64
Q

Lidocaine dosage for ventricular tachycardia

A

2 mg/kg

1 mL/10 kg

65
Q

Drugs that you can use 1 mL/10 kg dose

A

Lidocaine
Atropine
Epinephrine
Diazipam/Valium

66
Q

Causes of Obstructive Shock

A 
Causes: 
Physical blockage to venous return
GDV (stomach pushes on caudal vena cava; decreases venous return)
Pulmonary thromboembolism
Tension pneumothorax
Cardiac tamponade
67
Q

Obstructive Shock: Pathophysiology

A

Blockage of venous return -> decrease stroke volume -> decrease CO -> decrease perfusion of tissue -> shock

68
Q

Causes of Hypovolemic Shock

A

Causes:
Hemorrhage
Severe dehydration (GI loss, burns)

69
Q

Hypovolemic Shock:

Pathophysiology

A

Decreased effective circulating volume:
Blood loss or other body fluid loss (PU/PD, burns, vomiting, diarrhea)

Decreased CO:
Decrease venous return and SV

Decreased perfusion:
Decrease blood delivery to tissues

70
Q

Abdominocentesis

Spleen or free fluid?

A

Spleen: the sample will clot

Free fluid: abdomen or thorax the fluid will not clot

71
Q

What decreases first: PCV or TP? Why?

A

TP will because of splenic contraction

72
Q

Distributive Shock Causes

A

Anaphylaxis
Sepsis
Heart worm disease
Saddle thrombosis

Cold or hot extremities (depends on cause; sepsis will be hot)

73
Q

Vasopressors and what they are used for

A

Norepinephrine: septic shock
Dopmaine: inotrope (causes contraction and vasoconstriction)
Vasopressin: no effects on heart just peripheral vasoconstriction
Dobutamine (inotrope): cardiogenic shock

74
Q

Can a patient have more than one type of shock?

A

Yes!

Just figure out which one is primary

75
Q

What is COHDe?

A

Cardiogenic
Obstructive
Hypovolemic
Distributive

76
Q

Blood flow during cold shock

A

Blood flow goes to non-vital organs (skin, GI) opposed to vital organs (heart, kidney, brain)

Small Animal Medicine II (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions