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Anaesthesia and Fluid Therapy > Fluids > Flashcards

Fluids Flashcards

1
Q

What are the potential problems leading to fluid requirements?

A

Changes in volume, content and distribution

poor water intake

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2
Q

history of dehydration?

A

D+, V+, burns, exercise, haemorrhage, transport

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3
Q

What will be the urinary function leading to dehydration?

A

SG =1.045, bladder empty but normal output

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4
Q

Signs of 5% dehydration?

A

not detectable

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5
Q

signs of 5-6% dehyration?

A

subtle loss of skin elasticity

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6
Q

signs of 6-12% dehydration?

A

skin tenting, sunken eyes, dry mm

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7
Q

signs of 12-15% dehydration?

A

shock, rapid weak pulses, prolonged CRT, thirst, weightloss, neuro signs, vominting, fever.

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8
Q

What is hypovlaemia?

A

decrease in the volume of body fluids

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9
Q

how is hypovolaemia seen clinically?

A

reduced CRT, increased HR, mm grey, decrease pulse

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10
Q

What is hypotension?

A

decrease in blood pressure?

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11
Q

How can hypotension be monitored?

A

Invasive via arterial line, non-invasive via doppler or oscillometric technique

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12
Q

What is the purporse of maintanence fluids?

A

compensate for lack of intake, usually iso/hypotonic

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13
Q

What is the purpose of replacement fluids?

A

replace large volumes which have been lost.

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14
Q

What is a colloid fluid?

A

solution containing large particles
don’t easily leave the vascular space
expand plasma volume

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15
Q

what is a crystalloid fluid?

A

sodium based electrolyte solution
similar composition to plasma water
readily passes through cell membranes and equilibrates with intracellular fluid

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16
Q

Which direction do hypotonic solutions flow?

A

Flow into the cell

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17
Q

What are common crystalloids?

A

saline/NaCl 0.9%, hartmanns, dextrose 5

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18
Q

What are the properties of saline/NaCl 0.9%?

A

hypertonic, acidifying, no potassium, can induce hypernatraemia and hypercalcaemia.

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19
Q

What are the properties of Hartmanns?

A

isotonic, can induce hyponatraemia, risk of tissue oedema

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20
Q

what are the properties of dextrose?

A

5% glucose, hypertonic, water rapidly redistributed, risk of oedema.

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21
Q

What are the types of colloids?

A

synthetic or natural

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22
Q

What are the natural colloids?

A

oxyglobin and human serum albumin

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23
Q

what are the synthetic colloids?

A

gelatines, dextrans and straches

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24
Q

What quantity of fluids do you give to a dehydrated patient?

A

dehydration = maintanence + %dehydrated x BW

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25
Q

what quantity of fluids do you give to a hypovolaemic patient?

A

Crystalloids:
dog - 80-90ml/kg/h
cat - 50-55ml/kg/hr
plus 25% bolus

Colloids
dogs - 5ml/kg/hr
cats - 2-4ml/kg/hr

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26
Q

What is shock?

A

the imbalance between o2 delivery and o2 consumption so it does not meet the needs of the tissue.

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27
Q

what is hypocolaemic shock?

A

water, haemorrhage and electrolyte losses

28
Q

what is traumatic shock?

A

loss of fluids from damage tissues and alteration of normal vasomotor responses by pain

29
Q

what is cardiogenic shock?

A

failure of the cardiac pump

30
Q

what is vasogenic/distributive shock?

A

loss of vascular tone often secondary to sepsis, endotoxaemia, anaphylaxis or neurogenic injury

31
Q

What are the stages of shock?

A

compensatory, early decompensated and decompensatory stages.

32
Q

What occurs during the compensatory stage?

A

-barereceptor mediated release of catecholamines
-increases svr, hr and contractility and co
-neurohormonal response increases water retention and venous return
-requires large amount of energy
if successful at restoring circulating volume and CO then vasoconstriction will decrease.

33
Q

What occurs during the early decompensatory stage/.

A
  • blood redistributed to vital organs
  • decrease in o2 delivery causes anaerobic metabolism, lactic acidosis and tissue hypoxia
  • cell damage causing fluid extravasation to interstitium
  • release of myocardial depressant factor causing decrease in contractility and arrythmias
  • vasoconstriction of pulmonary vasculature - further o2 delivery impairment
  • reduced renal blood flow and urine output and tubular necrosis
  • microthrombi formation causing vascular occulsion and cell death or initiates disseminated introvascular coagulation
34
Q

What are the clinical signs during the early decompensatory stage?

A

decreased mentation, tachycardia, decrease in pulse pressure, hypotension, pale mucous membranes, prolonged crt, hypothermia

35
Q

What occurs during the compensatory stage?

A
  • prolonged hypoxia causes massive vasodilation in all organs leading to circulatory collapse
  • depressed mentation, bradycardia, cyanotic mm, serve hypotension, decrease urine output and hypothermia
36
Q

What are other things to monitor during shock?

A

improve oxygenation and cardiac output, reduce blood viscosity, thermoregulation, analgesia, treat metabolic disturbances, antibiotics, corticosteroids, anticoagulant therapy

37
Q

why are blood products administered?

A

to restore 02 carrying capacity, restore blood volume, provide clotting factors, platelets and plasma proteins, provide specific and non-sepcific antibodies

38
Q

What is major crossmatching?

A

assessing the effect that antibodies in the serum of the recipient have on donor cells which are transfused into the recipient

39
Q

what is minor crossmatching?

A

assess the effect of the donor serum on the recipient cells

40
Q

how many blood groups do dogs have?

A

8 - dog erythrocyte antigens 1-8

41
Q

What are the best dog donor groups?

A

DEA 1.1, 1.2 and 7 (DEA 1.1 positive most common)

42
Q

how likely is a blood reaction in dogs?

A

1st transfusion unlikely to cause reaction as body has not built up resistance to blood antibodies. if 2nd transfusion, in house card systems can be used to check if DEA 1.1 pos.

43
Q

What are the blood groups in cats?

A

one blood group with three different types - A,B and AB

44
Q

is blood typing essential in cats?

A

yes because antigens are highly immunogenic

45
Q

What feline blood groups can be transfused?

A

uk type A in DSH - if transfused with B causes mild reactions. Uk type B in pedigree cats and if transfused with A causes a rapid and fatal reaction. AB is rare and can be transfused with A or AB

46
Q

What animals are suitable for donation?

A

healthy young animals, 25+kg (4kg+ in cats), regularly wormed and vaccination UTD, females should be spayed. PCV should be 40%+ in dogs and 30%+ in cats. cats should be negative for retrovirus, mycoplasma haemofelis and coronavirus.

47
Q

How is blood collected?

A

DOnor may need sedation, jugular vein, aseptic technique, EMLA, dog blood collected into human blood donor bags with anticoagulation acid citrate dextrose (ACD) or citrate phosphate dextrose (CPD). cat blood collected into syringe containing 1.3ml ACD or CPD per 10ml blood collected.

48
Q

How much blood can be collected?

A

10-20% total blood volume
dogs - 88ml/kg
cats - 6ml/kg

49
Q

What are the properties of whole blood?

A

contains RBCs, clotting factors, plasma proteins, anti-inflammatory proteins and platelets.

50
Q

How should whole blood be stored?

A

in the fridge for upto 28 days

51
Q

When do you use whole blood?

A

2ml/kg will raise recipients PCV by 1%. use in acute/severe blood loss, anaemia and coagulopathies.

52
Q

What is packed RBCs?

A

centrifuged whole blood with plasma removed. PCV varies from 60-90%. can be resusplended in saline. use in cases of normovolaemic anaemia and hypovolaemic anaemia

53
Q

What are the properties of fresh frozen plasma? (FFP)

A

contains clotting factors and plasma proteins.

54
Q

How is fresh frozen plasma stored?

A

must be frozen within 6 hours but can be stored for 3 motnhs

55
Q

When do yo use fresh frozen plasma?

A

inherited and aquired coagulopathies, prolonged clotting times, immunoglobulin deficiencies. 10-30ml/kg over 4 hours

56
Q

what are the properties of frozen plasma?

A

frozen before 6 hours of collection, thawed and refrozen - contains vitamin K dependant factors. use in rodenticide toxicity

57
Q

What is cryoprecipitate?

A

produced from the plasma fraction of blood, must be frozen. use in cases of inherited clotting factor deficiencies - haemophilia.

58
Q

What are the signs of a blood transfusion reaction?

A

tachycardia, hypotensio, urticaria, facial oedema, v+, muscle tremors, panting, pyrexia

59
Q

What occurs in respiratory acidosis?

A

Acute

  • increased paCo2 and Hco3-
  • 1.5mEq/l increase in hco3- for every 10mmHg increase in Co2

chronic (2-5 days)

  • more acid excreted and hco3- retained
  • 3.5mEq/l increase in hco3- for every 10mmHg increase in co2
60
Q

What occurs in respiratory alkalosis?

A

fall in paco2 caused by hyperventilation - pain, stress, hypoxaemia.
Decrease in hCo3- as compensation

61
Q

what occurs in metabolic acidosis?

A

decrease in hco3- due to direct loss of bicarbonate or its consumption due to excessive levels of acids.
respiratory compensation - decreases in paco2 due to hyperventilation

62
Q

what occurs in metabolic alkaolsis?

A

increase in hco3- so respiratory compensation to increase paco2 and H+ to bind with Hcp3- to reduce it.

63
Q

What is base excess?

A

amount of acid needed to titrate 1l of blood to a ph of 7.4 at 37 degrees and a paco2 of 40mmHg. can be positive or negative.

64
Q

What is the average fluid intake for a horse?

A

54ml/kg/24hrs

65
Q

What routes can you give equine fluid therapy?

A

stomach tube or IV

66
Q

what blood groups do horses have?

A

8 blood groups with A and Q being most important

67
Q

what clinical equine conditions may require fluid therarpy?

A
  • lack of water intake
  • D+
  • intestinal obstruction
  • bladder rupture/ urinary tract obstruction
  • excessive sweating

Anaesthesia and Fluid Therapy (2 decks)

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