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ECC/Critical Care > IVFT > Flashcards

IVFT Flashcards

1
Q

Perfusion parameters of vasoconstrictive shock

A
  1. Obtunded
  2. MM colour: pale-white
  3. CRT >2
  4. HR: tachy in dogs, either in cats
  5. Weak-thready pulses
  6. Cold extremities
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2
Q

Perfusion parameters of vasodilatory shock

A
  1. Obtunded
  2. hyperaemic mm
  3. <1s CRT
  4. HR: tachy in dogs, either in cats
  5. Bounding pulses
  6. Warm extremities
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3
Q

How is total body water divided between the body compartments?

A

1/3 ECF and 2/3 ICF

w/in ECF 1/4 IV and 3/4 Interstitial

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4
Q

how are osmolality and osmolarity different?

A 
Osmolality = mOsm/kg of solution
Osmolarity = mOsm/L of solution
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5
Q

Define hyperosmolar

A

osmolality greater than plasma

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6
Q

Define hyposmolar

A

osmolality less than plasma

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7
Q

what is an ineffective osmole?

A

crosses the cell membrane freely and thus does not draw water out of the ICF

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8
Q

How do hypotonic fluids effect water moves?

A

water moves out of the ECF and into the ICF

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9
Q

how do hypertonic fluids effect water moves?

A

water moves out of the ICF and into the ECF

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10
Q

what are the 3 arms of starling’s forces?

A
  1. Hydrostatic pressure
  2. Oncotic pressure
  3. Endothelial permeability
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11
Q

define hydrostatic pressure

A

pressure generated w/in the capillary by the fluid w/in and directly proportional to volume

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12
Q

define oncotic pressure

A

a pressure gradient generated by the presence of numerous colloid molecules that do not readily cross the capillary endothelium

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13
Q

abnormal fluid losses are usually…

A

isosmolar (w/ the same salt conc. as the plasma) thus it is only lost from the ECF compartment

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14
Q

water will only move from the ICF when ??? changes

A

osmolality

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15
Q

free water loss can occur if..

A

kidneys are not functioning (and anti-diuretic hormone not doing its job) + decreased water intake

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16
Q

3 types of shock

A
  • circulatory
  • hypoxic
  • metabolic
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17
Q

types of circulatory shock

A
  • hypovolaemic (+haemorrhagic)
  • obstructive
  • cardiogenic
  • distributive/vasodilatory
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18
Q

causes of hypovolaemic shock

A

loss of salty water/plasma from the IV space eg. severe dehydration, rapid loss of plasma into the GIT, body cavity, interstitial space

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19
Q

causes of obstructive shock

A

when flow of blood bak into the right atrium, or from the right atrium to the left is prevented by physical obstruction
eg. pericardial effusion leading to right atrial tamponade, gastric dilation and volvulus (gas distended stomach compresses the CdVC and potentially the portal vein), severe PTE, severe heartworm infestation obstructing flow out of the right heart

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20
Q

causes of cardiogenic shock

A

disease of the myocardium itself

eg. DCM, endotoxin and cytokine release during sepsis, severe brady/tachyarrythmias

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21
Q

cause of vasodilatory/distributive shock

A

cytokines and other vasoactive mediators released w/ systemic inflam/anaphylaxis can cause endothelial dysfunction and dilation of the systemic arteries and arterioles, decreasing SVR

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22
Q

perfusion parameters of moderate vasoconstrictive shock

A
  1. mod-severe obtundation
  2. MM pale
  3. 2-3s CRT
  4. HR: increased/ poss. dec in cats
  5. Weak/poor pulses
  6. cool extremities
    ++ decreased BP
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23
Q

perfusion parameters of moderate vasodilatory shock

A
  1. Mod - severely obtunded
  2. MM hyperaemic
  3. <1sec CRT
  4. HR: inc/ poss dec. in cats
  5. Bounding to normal
  6. warm extremities
    ++ systolic and diastolic BP decreased
24
Q

Describe the pulse quality and blood pressure in severe shock (vasoconstrictive or dilatory)?

A

non-palpable pulses, unable to read BP

25
Q

list 3 isotonic crystalloids

A
  • 0.9% NaCl
  • Compounded sodium lactate (Hartmanns)
  • Plasmalyte-148
26
Q

shock volume for IVFT in dogs

A

20ml/kg

27
Q

shock volume for IVFT in cats

A

15ml/kg

28
Q

adverse effects of crystalloid fluids

A
  • large volumes required and pattern of distribution may result in haemodilution effects + interstitial oedema
  • rapid IV crystalloid fluid therapy may cause damage to the inner lining of blood vessels and perpetuate inflm and endothelial ‘leakiness’–> further tissue oedema
  • potentially harmful - lung dysfunction dt 75% of dose ending up in the interstitium
29
Q

list 3 colloid solutions

A
  • albumin
  • voluven/volulyte
  • gelofusine
30
Q

indications to use colloid solutions

A

patients with low COP (esp. those w/ acute protein losses)

31
Q

synthetic colloid fluid dose

A

5ml/kg

max dose over 1 day is 20ml/kg for dogs

32
Q

adverse effects of colloids

A
  • possible inc. risk of AKI, platelet and coag. dysfunction
  • anaphylaxis + hypersensitivities
  • artificial inc. USG, Total plasma protein
33
Q

max dose of hypertonic saline

A

6ml/kg over 5 min

34
Q

uses of hypertonic saline

A

large animals in shock whilst allowing time for large volumes of crystalloids to be infused

35
Q

indicators to use a vasopressor

A
  1. Patient received 50% BV IVFT and signs of vasodilatory shock
  2. Patient received full BV IVFT and still hypotensive
  3. Evidence of fluid overload (jug. distension, serous nasal discharge, chemosis) + hypotensive
  4. Septic shock suspected
36
Q

weak-moderate vasopressor

A

dopamine

37
Q

strong vasopressors eg.

A
  • norepinephrine
  • phenylephrine
  • epinephrine (adrenaline)
  • vasopressin
38
Q

CS of 10-12% dehydrated

A

marked prolongation of skin tent, dry mm, dry conjunctiva and sunken eyes. Animal may also start to show signs of hypovol.

39
Q

CS of 5% dehydrated

A

minimal amount of dehydration detected on PE; tacky mm, reduced tear film

40
Q

CS of 6-9% dehydrated

A

delayed skin tent, tacky-dry mm, reduced tear film

41
Q

which increases first with severe dehydration - urea or creatinine?

A

urea

42
Q

DDx for inc. PCV

A

splenic contraction during stress, dehydration

43
Q

Stepwise Qs to ask when formulating a fluid plan?

A
  1. Shock - type and severity
  2. Dehydration - %
  3. Lyte imbalances
  4. Metabolic acid-base
  5. Other: anaemia, hypoproteinaemia, XS losses
  6. Predisposition to overload - anuric/oliguric w/ AKI, cardiac disease
  7. Route and timeframe
44
Q

Steps to estimate the deficit volume

A

BW X % dehydrated = L
Rate: 6-12hr w/ acute dehydration (dog) and otherwise healthy, 12-24hr if CDV/renal disease
Cats 8-24hrs

45
Q

Maintenance rate of small dog

A

4ml/kg/hr

46
Q

Maintenance rate of large dog/cat

A

2ml/kg/hr

47
Q

estimate ongoing abnormal losses w/ severe vomiting (1x/hr)

A

1-2x maintenance

48
Q

estimate ongoing abnormal losses w/ moderate vom (q6h)

A

0.5xmaintenance

49
Q

vom once very 12hrs ongoing losses rate?

A

0.25 maintenance

50
Q

examples of isotonic fluid loss

A

V+/D+
PU
Fluid accumulation in third space - GIT space, peritoneal, pleural

51
Q

example of hypotonic loss

A
  • secretory D+ eg. neonatal D+ in calves

- third spacing of water into the GIT after ingesting hyperosmolar material ie salt/paintballs

52
Q

example of hypertonic losses

A

patients w/ hypoA and aldosterone deficit –> lack of ability to retain sodium and conserve water –> obliate PU and more rapid dehydration if that patient is also anorexic, + V/D+ (dt reduced circulating cortisol)

53
Q

indications to use 0.9%NaCl

A
  • hypercalcaemia

- metabolic alkalosis (dilutes XS bicarb w/ chloride)

54
Q

indications to use LRS

A
  • correcting metabolic acidosis
55
Q

indications to use plasmalyte-148

A
  • hypomagnesaemia

- severe liver dysfunction unable to metabolise lactate - as uses gluconate and acetate as bicarb precursor

56
Q

how does 0.45% NaCl + 2.5% dextrose behave?

A

Half strength sodium’ (half normal ECF sodium conc.) about half the V of fluid being given will act like replacement fluid for ECF and half will behave as free water once the glucose molecules are metabolised.

ECC/Critical Care (5 decks)

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