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CVSOH BVSc3 > Fluids > Flashcards

Fluids Flashcards

1
Q

What is hypovolaemia?

A

When fluid is lost rapidly from the intravascular space (in vessels)

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2
Q

What is dehydration?

A

Fluid is lost slowly from the extravascular compartment (cells)
Redistribution means loss from all compartments

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3
Q

What are the physiological consequences of hypovolaemia?

A 
Reduces preload
Reduces stroke volume
Reduced CO
Vasoconstriction
Tachycardia
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4
Q

How do you assess intravascular volume?

A

HR
MM colour
CRT
BP

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5
Q

What is normal CRT?

A

<2 secs

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6
Q

How do you assess extravascular volume?

A

Moistness of MM
Skin turgor/tenting
Weight
Eye globe position

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7
Q

What are the physical exam findings of <5% dehydration?

A

No signs

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8
Q

What are the physical exam findings of 5-6% dehydration?

A

Tacky mucous membranes

Mild skin tent delay

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9
Q

What are the physical exam findings of 6-8% dehydration?

A

Dry mucous membranes
Mild increase in CRT ~2 secs
Mild/moderate skin tent delay
Maybe sunken eyes

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10
Q

What are the physical exam findings of 10-12% dehydration?

A 
Dry mucous membranes
CRT >2-3 seconds
Signs of shock
Marked skin tent
Sunken eyes
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11
Q

What are the physical exam findings of >15% dehydration?

A

Death

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12
Q

What can affect assessment of dehydration?

A

Hypersalivation
Subcut fat
Skin folds

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13
Q

How should you correct dehydration?

A

Slowly

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14
Q

How should you correct hypovolaemia?

A

Rapidly

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15
Q

What is the best type of fluid available for hypovolaemia treatment?

A

Isotonic crystalloids

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16
Q

What are crystalloids?

A

Solutions containing solutes eg. electrolytes

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17
Q

What are the two types of isotonic crystalloids?

A

0-9% NaCl and Hartmann’s

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18
Q

Why are isotonic solutions the best?

A

Dont shift water from intracellular to extracellular compartments

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19
Q

What does Hartmann’s contain that 0.9% NaCl doesnt?

A

Potassium and chloride - more balanced

Lactate - treat acidosis

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20
Q

When should you not use Hartmann’s?

A

Do not mix with blood products or sodium bicarbonate - risk of clotting/precipitation

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21
Q

When should you not use 0.9% NaCl?

A

When there is acidosis - can exacerbate

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22
Q

When are hypotonic crystalloids used?

A

Rarely - maybe severe hypernatremia

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23
Q

When are hypertonic crystalloids used?

A

Commonly in large animals - need less fluid

Used for hyponatremia and intracranial hypertension

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24
Q

What are colloids?

A

Large molecules that cant cross semipermeable membranes

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25
Q

What effect do colloids have on the body?

A

Increase the osmotic pressure so need less fluid to resuscitate

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26
Q

When are colloids used?

A

Rarely - hypovolaemia

Have lots of risks

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27
Q

What are some risks of colloids?

A

Coagulopathy
Allergic reactions/anaphylaxis
(also expensive)

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28
Q

What are some complications of fluid therapy?

A

Heart disease/failure
Renal disease
Resp disease
Volume overload

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29
Q

What are some signs of volume overload?

A

Pulmonary oedema
Venous engorgement - jugular distension
Peripheral oedema - conjunctiva, ocular discharge

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30
Q

What is the formula for fluid requirement?

A

Extravascular fluid deficit + maintenance requirements + ongoing loss

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31
Q

How do you work out the extravascular fluid deficit?

A

Estimate the % dehydration

% dehydration x body weight x 10

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32
Q

What is the formula for the maintenance requirement?

A

2ml/kg/hr

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33
Q

How do you work out the ongoing loss?

A

Depends on amount lost in vomiting, diarrhoea etc.

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34
Q

What is shock?

A

An imbalance between oxygen delivery and consumption by the tissues
= Not enough oxygen to tissues
Causes cellular/tissue hypoxia

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35
Q

What is shock most commonly caused by?

A

Hypoperfusion

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36
Q

What are the 4 types of circulatory shock?

A

Hypovolaemic
Cardiogenic
Obstructive
Distributive

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37
Q

What is hypovolaemic shock?

A

Shock due to decreased blood volume - haemorrhagic or non-haemorrhagic

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38
Q

What is cardiogenic shock?

A

Forward/pump failure causing reduced cardiac output

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39
Q

What are some examples of causes of cardiogenic shock?

A

Systolic dysfunction
Diastolic dysfunction
Bradyarrhythmias
Tachyarrhythmias

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40
Q

What is obstructive shock?

A

Due to physical obstructions in blood flow to or from the heart/major blood vessels

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41
Q

What are some examples of causes of obstructive shock?

A

Gastric dilatation-volvulus (GDV)

Pulmonary thromboembolism

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42
Q

What is distributive shock?

A

Due to maldistribution of blood flow - usually widespread inappropriate vasodilation

43
Q

What are some examples of causes of distributive shock?

A

Anaphylaxis
Sepsis
Burns/trauma

44
Q

What is the physiological response to hypovolaemic shock?

A

Adrenaline release
Renin-angiotensin-aldosterone system activation
ADH release
Splenic contraction

45
Q

Why is adrenaline released during hypovolaemic shock?

A

Increases HR

Increases peripheral vasoconstriction

46
Q

Why is the renin-angiotensin-aldosterone system released during hypovolaemic shock?

A

Increases sodium and water retention and peripheral vasoconstriction

47
Q

Why is ADH released during hypovolaemic shock?

A

Increases water retention

48
Q

Why does splenic contraction occur during hypovolaemic shock?

A

Releases more RBCs into circulation

49
Q

How is hypovolaemic shock classified?

A

Compensated - body is successfully maintaining tissue perfusion
Decompensated - Body is failing and patient is in danger

50
Q

What are the common features of hypovolaemic shock in cats?

A

Bradycardia
Hypothermia
Cats are much less predictable

51
Q

How do you treat hypovolaemic shock?

A

Rapid administration of fluids - isotonic crystalloids
Blood transfusion - severe or if anaemic
Check still not losing fluids

52
Q

What size bolus do you give a dog for hypovolaemic shock?

A

10-20ml/kg

53
Q

What size bolus do you give a cat for hypovolaemic shock?

A

5-10ml/kg

54
Q

What is the shock dose?

A

Equates to the total blood volume of the patient - dont give full shock dose!

55
Q

What is the shock dose in dogs?

A

80-90ml.kg

56
Q

What is the shock dose in cats?

A

50-55ml/kg

57
Q

What is the target urine output for determining efficacy of treatment?

A

> 0.5ml/kg/hr

58
Q

How much hypertonic fluid should be administered if used once?

A

4ml/kg

59
Q

What lab tests are used in fluid therapy?

A

Packed cell volume

Total solids

60
Q

What does both increases PCV and TS indicate?

A

Dehydration - slow so time for RBCs to increase

61
Q

What does both decreased PCV and TS indicate?

A

Haemorrhage

Anaemia

62
Q

What does decreased PCV but normal TS indicate?

A

Haemolytic anaemia

63
Q

What does normal PCV but decreased TS mean?

A

Acute haemorrhage

Or hypoproteinaemia

64
Q

How can a urea dipstick help with fluid therapy?

A

Increase in urea can indicate dehydration - pre-renal

65
Q

What is the name of the group of tests used to support assessment of sick patients needing fluid therapy?

A

The minimum database

66
Q

What diseases might need a blood transfusion?

A

Hypovolaemic anaemia
IMHA
Coagulopathies
Thrombocytopaenia

67
Q

When should you give a blood transfusion to an anaemic patient?

A

If there are clinical signs of anaemia - not just based on PCV alone

68
Q

What are the 4 different types of blood products available?

A

Whole blood
Packed RBCs
Fresh frozen plasma and frozen plasma
Cryoprecipitate

69
Q

What animals is blood transfusion available for?

A

Dogs

No blood banks for cats but can obtain locally

70
Q

How do you get packed RBCs/plasma?

A

Hard spin centrifugation of whole blood - separates them out

71
Q

What counts as fresh whole blood compared to stored whole blood?

A

Fresh whole blood - <6 hrs after collection

Stored - >8 hrs after

72
Q

What is found in fresh whole blood that isnt found in stored whole blood?

A

Some functional platelets
Clotting factors
(Both have RBCs)

73
Q

What is the PCV of packed RBCs?

A

70-80%

74
Q

What does fresh frozen plasma contain?

A

All coagulation factors

Albumin/proteins

75
Q

How is fresh frozen plasma stored?

A

Stored at -20 to -40 degrees for less than a year

76
Q

What is frozen plasma?

A

Plasma that has been stored for >1 year

Or that has been thawed and refrozen

77
Q

What does frozen plasma not contain that fresh frozen plasma does?

A

Labile factors are lost - VIII and vWF

78
Q

How long can frozen plasma be stored for?

A

Up to 5 years

79
Q

What is found in both fresh frozen plasma and frozen plasma?

A

Stable coagulation factors

80
Q

How is cryoprecipitate made?

A

By slowly partially thawing fresh frozen plasma and then centrifuge it again

81
Q

What is cryoprecipitate rich in?

A

Fibrinogen, VIII and vWF

82
Q

When is cryoprecipitate used?

A

In von Willebrands disease and haemophilia A

Not used very commonly

83
Q

What disease is fresh whole blood the ideal option for?

A

Blood loss anaemia

84
Q

What disease is fresh frozen plasma the ideal option for?

A

Unknown coagulopathy

85
Q

What disease is frozen plasma the ideal option for?

A

Rodenticide toxicity

86
Q

What disease is packed red blood cells the ideal option for?

A

Euvolaemic anaemia - normal blood volume but loss of RBCs

87
Q

How many different blood types are there in dogs?

A

6

88
Q

Which is the only dog erythrocyte antigen that be we can type for in clinical practice?

A

DEA 1.1 - can be positive or negative

89
Q

What blood should DEA1.1 negative dogs recieve?

A

Only DEA 1.1 negative blood

90
Q

What blood should DEA1.1 positive dogs recieve?

A

Either DEA 1.1 positive or negative blood

91
Q

What blood type should be given in an emergency in dogs?

A

DEA1.1 negative blood

92
Q

What does the blood of a sensitised DEA1.1 negative dog contain?

A

RBC doesnt have a DEA1.1 antigen

But its plasma contains anti-DEA1.1 antibodies

93
Q

What causes a transfusion reaction to DEA1.1?

A

If a DEA1.1 negative dog is given DEA1.1 positive blood twice
Anti-DEA1.1 antibodies developed the first time will kill the second lot of DEA1.1 positive blood

94
Q

Do dogs and cats get naturally occurring alloantibodies?

A

Dogs dont

Cats do - born with antibodies against other blood types so dont need sensitisation for a transfusion reaction

95
Q

What are the 3 blood types in cats?

A

A, B and AB

96
Q

Which cat blood type is the most reactive?

A

Type B - has lots of anti-A antibodies

97
Q

Which blood type should be given to a type AB patient?

A

Type AB

If not available then give type A

98
Q

What is a major crossmatch?

A

Testing the recipients serum with donor RBCs

99
Q

What is a minor crossmatch?

A

Testing the donor serum with recipient RBCs

100
Q

When should crossmatching occur?

A

When the recipient has received a transfusion more than 4 days ago

101
Q

What is the difference between open and closed donation?

A

Open - more than one site of potential contamination

Only one exposure

102
Q

Over what time period do you give a blood transfusion?

A

4-6 hours

103
Q

How do you begin administering a blood transfusion?

A

1ml/kg/hr for 20 mins - slow to allow early recognition of transfusion reactions

104
Q

How often should you monitor transfusions?

A

Every 15-30 mins during

1, 12 and 24 hrs after

CVSOH BVSc3 (60 decks)

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