Misc Flashcards
SIRS
-Systemic inflammatory response syndrome
-clinical state of systemic inflammation
Causes of SIRS
-Infectious
-Non-infectious (panky, polytrauma, burns, heatstroke, neoplasia, immune-mediated disease, post-op)
SIRS criteria
Diagnosis of SIRS consist of fulfilling 2 out of the following 4 criteria in dogs and 3 out of 4 criteria in cats:
(1) increased or decreased temperature
(2) tachycardia (or bradycardia in cats)
(3) tachypnea
(4) leukon abnormalities
Sepsis-2
- categorizes patients into 3 groups: sepsis, severe sepsis, septic shock based on the presence of infection, SIRS, MODS, and refractory hypotension
Sepsis-3
-Categorizes patients into 2 groups (sepsis and septic shock) based on the presence of infection with organ dysfunction, refractory hypotension, and persistently increased lactate despite appropriate resuscitation
-Selects for patients with more severe cases of sepsis and higher risk of death compared to Sepsis-2
Branched amino acids
leucine, isoleucine, valine
Gq receptors
-activates IP3, DAG
-Alpha 1, endothelin, V1, M1, M3, M5, H1
Gs receptors
Activates cAMP -> PKA
- B1
-B2
-V2
-Adenosine
-H2
-glucagon
Gi receptors
-prevents conversion to cAMP
-M2
-M4
-alpha 2
-opioids
-D2
-Somatostatin
-GABA b
Metabolic derangements seen with refeeding syndrome
Hypophosphatemia, hypomagnesemia, hypokalemia, hyponatremia, hypocalcemia, hyperglycemia, and vitamin deficiencies
Processes body uses to maintain acid-base balance
1) regulation of PCO2 by alveolar ventilation
2) buffering of acids by bicarbonate and non- bicarbonate buffers
3) changes in renal excretion of acid or base
Traditional acid base approach
Uses the Henderson - hasselbach equation for carbonic acid and uses pH, PCO2, and bicarb concentration.
PH has a direct relationship with bicarb concentration and an inverse relationship with PCO2
Purpose of anion gap
To identify the cause of a metabolic acidosis
Unmeasured anions are more abundant than unmeasured cations, the AG is essentially a marker of the amount of unmeasured cations
Measured cations
Sodium, potassium
Account for 95% total cations
Measured anions
Bicarb, chloride
Accounts for 85% total anions
Unmeasured cations
Albumin, lactate, phosphates, sulfates, ketones
Some drugs and toxins can also account for it, including methanol, salicylate, and ethylene glycol
Causes of increased ion gap metabolic acidosis
DUEL
-DKA
-Uremia
-Ethylene glycol
-Lactic acidosis
-Salicylate, Methanol (toxins)
Causes of hyperchloremic metabolic acidosis
-Renal bicarb loss
-GI bicarb loss
-NaCl administration
-Addison’s
Metabolic acidosis
Decreased pH, HCO3-, PCO2
Metabolic alkalosis
Increased pH, HCO3-, PCO2
Normal anion gap for dogs and cats
10-15 mEq/L
> 25 = acidotic
Data Types
1) Categorical
-Nomial (order doesnt matter)
-Ordinal (order matters)
Includes: frequencies, proportiins, percentages, pie charts
2) Numerical
-Discrete (counted, not measured)
- Continuous (measured)
Includes: percentiles, means, medians, modes, box plots
Standard error
How far is the samole mean likely to be away rrom the actual (population) mean, describes the sampling process
Standard deviation
Describes the variation within the population/sample, how far an individual is from the population mean
Type I errors
False positive
Rejection of the null hypothesis when you shouldn’t
Type II errors
False negative
Acceptance of the null hypothesis when you shouldn’t
Sensitivity
(True positive/ (true + false negative)) x 100
Specificity
(True negative/(true positive+ false negative)) x 100
PPV
(true positive/ (true positive + false positive)) x 100
NPV
(true negative/ (true negative + false negative)) x 100
Hospital-associated infection (HAI)
-nosocomial
-infectious event diagnosed >48 hours after hospital admission, or more specifically, on or after the third hospital day without proven prior incubation
How common are nosocomial events?
-16.3% in dogs
-12% in cats
True or False: HAIs in ICU are thought to originate either from the patient’s own endogenous flora or from exogenous sources
True
What bacteria is a serious threat to critically ill animals?
Carbapenem-resistant Enterobacteriaceae
Massive Blood Transfusion
Replacement of one entire blood volume within 24 h
Transfusion of >10 units of packed red blood cells (PRBCs) in 24 h
Transfusion of >20 units of PRBCs in 24 h
Transfusion of >4 units of PRBCs in 1 h when on-going need is foreseeable
Replacement of 50% of total blood volume (TBV) within 3 h.
Sepsis
Defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection
Septic shock
Subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality.
What is a potential complication of parenteral nutrition?
Hyperglycemia
SOFA Score
Sequential Organ Failure Assessment
-used to assess organ dysfunction in several different ICU settings
-correlates with survival
-assigns between 0-4 points to each of the 6 individual organ systems (total score 24)
-higher scores = worse outcome
ATT
Animal Triage Score
Higher score = poorer prognosis
6 categories, 18 points total
ATT
-Animal Trauma Triage
-profusion, cardiac, respiratory, eye/muscle/integument, skeletal, neuro
- out of a total of 18 points
-higher = more severe
-each point increase indicates a 2.3 to 2.6x decrease in survival rate
Pain vs Nociception
-Pain is the unpleasant sensory and emotional experience associated with actual or potential tissue damage (conscious experience)
-Nociception is the detection of a noxious stimulus at the tissue level by nociceptors (mechanical, thermal, chemical)
Inflammatory mediators that induce pain sensation
Bradykinin, prostaglandins, leukotrienes, serotonin, histamine, substance P, thromboxanes, IL, TNF
Nociceptive Pathway
-transduction, transmission, modultaion, projection, perception
Analgesic effects of transduction
- local anesthetics
- opioids
- NSAIDs
- corticosteroids
Analgesic effects on transmission
-local anesthetics
-alpha 2 agonist
Analgesic effects on modulation
-local anesthetics
-alpha 2 agonist
-opioids
-NSAIDs
-benzodiazepines
-NMDA antagonist
-TCA antidepressants
-anticonvulsants
Analgesic effects on perception
- general anesthesia
- opioids
- alpha 2 agonist
- benzodiazepines
- phenothiazines
Complications of transfusion reactions
Infectious versus more commonly non-infectious
Non-infectious breaks down into acute (<24 hours) versus delayed
Acute non-immune:
Transfusion related sepsis
Transfusion related circulatory overload (TACO)
Metabolic derangements
Dilutional coagulopathy
Acute immune:
Acute hemolytic transfusion reactions
Febrile non-hemolytic transfusion reaction
Allergic reactions
TRALI
Delayed non-immune:
Iron overload
Delayed immune:
Delayed hemolytic transfusion reaction
Post transfusion purpura
Transfusion associated graft versus host disease
Incidence of reaction
0-38%
TACO
Transfusion associated circulatory overload
Acute non-immunologic reaction secondary to increases in blood volume mediated by transfusion
-acute respiratory distress
-hydrostatic pulmonary edema
-occurs within 6 hours of transfusion
Evidence of left atrial overload
TRALI
Closely mimics taco but is different in the sense that it is a inflammatory trigger that increases capillary permeability and causes exudative pulmonary edema
Antigen-antibody reaction in the lungs
No prior lung injury
No evidence of left attial hypertension
TRALI I
No risk factors for ARDS
PF < 300
Clear evidence of bilateral pulmonary edema on rads
No evidence of left atrial hypertension
Onset within 6 hours
TRALI II
Similar to type one but also includes patients that are at risk for ARDS
TRALI vs TACO
CURATIVE guidelines for FATE
Recommend treatment for thrombophylaxis
Recommends use of clopidogrel, UFH, LMHW
Recommends AGAINST aspirin as the sole anti thrombotic
Warfarin should not be used
Rivaroxaban recommended
Apixaban not mentioned but has shown to be well tolerated in cats
