Misc Flashcards
What recumbency should you record an ECG in?
How many leads should you use?
Right lateral
Minimum 6 can use 12
Aldosterone
Made be the adrenal cortex
Causes sodium and water retention
Causes potassium loss
How does hypothermia cause bradycardia?
Causes decreased cardiac depolarisation
Decreases HR
Decreases CO
What does RAAS stand for?
What are the steps?
Renin angiotensin aldosterone system
1. Drop in BP sensed
2. JG cells in the kidney produce Renin
3. Angiotensinogen released from the Liver
4. Angiotensin I created
5. Converted via ACE to angiotensin II
6. Angiotensin II causes vasoconstriction and promotes the release of Aldosterone and ADH
Cells in the Pancreas and what they produce
Alpha cells - Glucagon
Beta - Insulin
Delta - Somatostatin
F Cells - Pancreatic polypeptide
Main electrolyte abnormalities with DKA
Hypokalaemia
Hyponatraemia
Hypophosphataemia
Hypomagnaesaemia
Calculation of free water deficit
BW x 0.6 x (Measured Na/140)
Information about Magnesium
2nd most abundant cation
Intracellular, less than 1% found in serum
Difficult to measure as only the ionised is active
Can be supplemented if refractory hypokalaemia
0.25-1mEg/kg/24hrs iv
Drugs that cause/ worsen hyperkalaemia
Ace inhibitors (enalapril or benazepril Fortekor)
Angiotensin receptor blockers (losartan and telmisartan Semintra)
Heparin
Cyclosporin
Tacrolimus
NSAIDS
Trimethoprim
Non-specific beta blockers
Cardiac glycosides
Renal threshold for glucose
Dogs 200 mg/dL (11)
Cats 220 mg/dL (12)
Difference between PvCo2 and PaCo2
PvCo2 is 5-10mmHg higher
Receptors in the CRTZ
Nk1
Dopamine
Serotonin
Histamine
Muscarine
Enkephalin
Alpha-2 Adrenergic
What receptors does maropitant act on
Nk-1 in the CRTZ
Why do severely anaemic patients not become cyanotic?
To become cyanotic you must have a haemoglobin level of above 5 (HTC 15%)
What temperature should you start active cooling?
Above 105.8 (41)
Plasma osmolality equation and normal
(2xNa) + BUN/2.8 + Glu/18
Normal 300
What is glyconeogenesis?
When the liver converts glucose to glycogen for sugar storage
Difference between endocrine and exocrine
endocrine - hormones
exocrine - enzymes
Normal blood lactate?
Indication of survival
Less than 2-2.5
How quickly it reduces
When performing abdominocentesis on a GDV which side should if be performed on and why?
Left lateral, perform from the right, to avoid the spleen
ARDS diagnosis
Berlin criteria
Acute onset - less than 72hrs
Prescence of a primary dx process that causes enough inflammation to set up a reaction in the lungs
Evidence of pulmonary oedema without heart failure or fluid overload
Evidence of inefficient gas exchange (P/F ratio >300)
P/F ratio >100 severe
100-200 moderate
200-300 mild
6 Organs involved in the SOFA score and Parameters measured
Respiratory
Liver
Cardiovascular
Renal
Coagulation
CNS
P/F ratio
Platelet count
Total bilirubin
Crea
MAP BP
GCS
3/4 Stages of ARDS
- Exudative
Type 1 pneumocystis are damaged- they are in charge of gas exchange, they cannot multiply - Proliferative
Type 2 pneumocytes multiply- secrete surfactant - Fibrotic
- Recovery
Types of fluid found in the pleural space
Disease processes associated with them
Transudate
Clear, low cell count, low protein count
Associated with decreased oncotic pressure- hypoalbuminaemia
Modified transudate
Most common, higher cell count
Associated with increased hydrostatic pressure- Heart failure
Exudate
High cell count, bacteria, lymphocytes
Pyothorax, chylothorax
What is MDR-1
Implications of genetic predisposition and not having it
Multi-Drug resistant protein - 1
Removes foreign substances out of cells in the GI tract, kidney, liver. Cannot stop drugs crossing the blood brain barrier
drugs have a larger effect, animals more sensitive
Things that affect absorption of drugs administered PO
Stomach, gastric motility
Lack of small intestinal motility. Drug can be reabsorbed + build up to toxic doses
Food in the stomach
Gastric pH
Increased permeability of the GI tract-more absorption
What is pharmacokinetics?
What is ADME?
The study of how drugs pass through the body
Absorption
Distribution
Metabolisation
Excretion
Drugs that activate the P450 system and increase metabolism
Phenobarbitone
St johns wort
Phenylbutazone
Drugs that decrease the metabolism of other drugs
Erythromycin
Grapefruit juice
Omeprazole
Cimetidine
Chloramphenicol
What causes the oxyhemoglobin curve to shift to the right?
decreased pH
Increased temperature
What causes the oxyhemoglobin curve to shift to the left
Increased pH
Decreased temperature
What causes the oxyhemoglobin curve to shift to the left
Normal circulating blood volume
90ml/kg dogs
55ml/kg cats
How much FFP does it take to increase albumin by 1g/L (10g/L UK)
45ml/kg
Units for albumin and the difference?
Normal range
US g/Dl
Uk g/l
x10
3.2-4.1
4 types of hypoxia
Hypoxic
Hypaemic
Histiotoxic
Metabolic
5 causes of hypoxaemia
V/Q mismatch
Low partial pressure of inspired O2
Diffusion impairment
Anatomical shunting
Hypoventilation
What is shock
A severe imbalance between oxygen supply and demand. Leading to inadequate cellular energy production, cellular death and multi-organ failure
Units for creatinine and how to convert
x88
US mg/dL
UK mol/L
Differences between abdominal fluid and peripheral blood that can show uroperitoneum
Potassium x1.4 more
Creatinine x2 more
What vitamin helps with the absorption of calcuim
Vitamin D3
Cholecalciferol
What are kupffer cells and were are they found?
Macrophages found in the liver
Remove bacteria from the blood
Definition of sepsis
A life threatening organ dysfunction caused by a dis-regulated host response to infection
Metabolic deficits seen with hepatic lipidosis
Glutathione
Taurine
Vitamin K
Vitamin B
Definition of septic shock
A subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality
Inability to maintain BP abouve 65MAP despite adequate fluid resuscitation without vasopressors
Lactate will not go below 2
Where is glucagon produced?
What does it do?
In the pancreas
Stimulates the liver to convert stored glycogen to glucose for energy
Which vitamin is needed for the production of haemoglobin?
Where is it stored?
B12 Liver
Drugs you wouldn’t give to patients with kidney problems
NSAIDS
Some diuretics
Some antibiotics
Tetracyclines and Sulphomimides
Corticosteroids
Decreased clearance, narrow safety margins
Differences between abdominal fluids and peripheral blood that can show septic effusion
Glucose lower in effusion (20)
Lactate higher (2)
Effects of metabolic acidosis on the body
Shifts oxyheam curve to the right
Decreases cardiac contractility
Decreased CO
Tachycardia
Decreased arrhythmia threshold
Catecholamine resistance
Peripheral arteriolar vasodilation
Venoconstrication of peripheral veins
Pulmonary arteries vasoconstrict
Insulin resistance
Hyperkalaemia (K swapped from cells with H)
Risks associated with administration of sodium bicarbonate
Calculation for the amount needed
Paradoxical cerebral acidosis
Increased Co2 production
Hypercapnia
Increased sodium and osmole concentration
Circulatory system overload
Iatrogenic metabolic alkalosis
Changes to oxyhemoglobin curve
Hypocalcaemia
Hypokalaemia
mEg of bicarbonate needed = 0.3xBWxbase excess
2 major stimuli for ADH release
Elevated plasma osmolality
Decreased effective circulating volume
Effects of alkalosis on the body
Muscle spasms
Stuporous mentation
Hypocalcaemia
Hypokalaemia
Difference between anions and cations and examples of both
cations are positively charged
K+
Na+
Mg+
Ca+
Cl-
HCO3-
P-
How to convert glucose and the units?
UK mmol/l
US mg/dL
/18
What is apheresis
When the blood is removed from the patient and separated into its components
One or more components id removed or processed and the blood is returned to the patient
Therapeutic plasma exchange
What type or reaction is anaphylaxis?
IgE mediated hypersensitivity reaction
Stages of hypovolemic shock and clinical signs associated
Compensatory
Vasoconstriction
Splenic contraction
Tachycardia
Rapid CRT
Injected mm’s
Early decompensatory
Tachycardia
Hypotension
Weak pulses
Pale mm’s
Prolonged CRT
Cool extremities
Increase in resp rate and effort
Decreased mentation
Late decompensatory
Bradycardia
Severe refractory hypotension
Pale/cyanotic mm’s
Undetectable CRT
Weak/absent pulses
Hypothermia
Decreased mentation
Prolonged and severe tissue hype-perfusion causes ATP deplation, anaerobic respiration and cellular death
What is cardiac afterload
The force that the ventricles must overcome to open the semi-lunar valves
What is cardia preload
The volume in the ventricles at the end of diastole
Nasal oxygen dose
50-150 ml/kg/min
A-a Gradient and normal limits
PAO2-PaO2
PAO2=
(FiO2x713)-(PaCo2/0.8)
Normal = 5-15
How to calculate MAP
((Diastole x 2)+ Systole) / 3
What is released during anaphylaxis
Histamine
Cytokines
Heparin
Tryptase
Prostaglandins
Platelet activating factor
What receptors does histamine bind to?
What effects are seen due to this?
H1-H4
(GI, CV and resp systems)
Respiratory signs, smooth muscle contraction, bronchospasm, mucus secretion, oedema formation
Cardiogenic shock
Dysrythmias
Cardiac ischaemia
Gastric acid production
Puritis
Increased vascular permeability
Vasodilation
Normal level of lactate
> 2.5
