GDV Flashcards

1
Q

Main cardiovascular, respiratory and GI system dysfunctions in a GDV patients are?

A
  • Decreased cardiac output due to lowered intravascular volume creating diminished venous return and leading to shock
  • Decreased coronary blood flow, myocardial ischemia and catecholamine release = ventricular arrhythmias
  • Respiratory dysfunction from dilatation impending caudal movement of the diaphragm results in hypoventilation
  • Gastric necrosis and hemorrhaging due to hypoperfusion and physical damage due to stretching
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2
Q

What is the primary goal of treatment for GDV?

A

Correct and eliminate the cause of shock

-aggressive fluid therapy to provide better intravascular volume

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3
Q

How is sedation for gastric decompression usually achieved?

A

A combination of a pure-mu agonist opioid and a benzodiazepine

  • opioids have very little cardiovascular consequences with minimal effect on blood pressure
  • benzodiazepines have very minimal effects to cardiovascular and respiratory system, wide margin of safety and provide sedation and muscle relaxation
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4
Q

What drugs should you avoid using in a GDV patient?

A

Morphine and meperidine as they can cause histamine release and contribute to hypotension

Phenothiazines (Acepromazine) -avoid as can cause peripheral vasodilation and contribute to hypotension, no reversal agent

Alpha-2 agonist: cause bradyarrhythmias and reduce cardiac output

Induction with barbiturates (thiopental): can cause peripheral vasodilation

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5
Q

Ketamine + opioid and benzodiazepine for GDV

A
  • Good as it increases cardiac output and blood pressure

* Not good when already tachycardic

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6
Q

Etomidate used in GDV

A
  • Pros: rapid induction, minimal changes in cardiovascular status
  • Cons: if adrenocortical suppression is detrimental (sepsis, SIRS)
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7
Q

Propofol as induction agent in GDV

A

Pros: rapid induction
Cons: apnea and hypotension due to respiratory depression and vasodilation

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8
Q

What drug would you use to pretreat for vagal stimulation in a GDV patient?

A

A anticholinergic

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9
Q

What is lidocaine routinely used for GDV?

A

Not only for it’s antiarrhythmic and analgesic effect

  • Also a free radical scavenger
  • Reduces ischemic damage and reperfusion injury
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10
Q

What kind of anesthetic would you consider for a hemodynamically unstable or those showing negative signs towards inhalants?

A

TIVA (Total intravenous anesthesia)

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11
Q

What drugs would you consider if hypotension persist in a GDV patient despite IVF and minimal anesthetic agents?

A

Positive inotropes and vasopressors (dopamine, Dobutamine, norepinephrine, and vasopressin)

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12
Q

What kind of arrhythmias are common in GDV patients and what are the causes?

A

Ventricular arrhythmias. Myocardial ischemia, lactic acidosis, electrolyte imbalances, reperfusion injury

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