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Clinical Medicine Master > SA Fluids (MR) > Flashcards

SA Fluids (MR) Flashcards

1
Q

Definition of Shock?

A

The state in which profound and widespread reduction of effective tissue perfusion leads first to reversible, and then, if prolonged, to irreversible cellular injury

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2
Q

How often is just one type of shock occurring?

A

Not often

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3
Q

Anatomic Shock Classification: List types?

A

Cardiogenic (heart) - CO output problem
Hypovolemic (blood) - Volume loss
Obstructive (vessels) - Ex. GDV massive pressure collapse of vena cava
Distributive (vessels) - Massive Vasodialation - Anaphylaxis

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4
Q

How will you recognize Compensated Shock?

A

Mild increases HR/RR
Normal mentation and blood pressure
Maybe ‘brick red’ MM
CRT < 1 s in some forms

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5
Q

Early Decompensated Clinical Signs?

A 
Tachycardia 
Tachypnea  
Pale MM - peripheral vasoconstriction  
Prolonged CRT   
Weak pulse quality   
Depressed mentation  
Usually Hypothermic   
Hypotension
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6
Q

Terminal (Decompensated) Clinical Signs?

A

Low HR in spite of low CO
Absent CRT
Severe hypotension!!!

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7
Q

The Adaptive Response to shock?

A

Neurohormoral Response:
Sympathetic stimulation
Renin-Angiotensin- Aldosterone secretion
Anti-Diuretic Hormone
Selective Vasoconstriction to preserve vital organ function - increase profussion

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8
Q

Progression of Shock Syndrome: The adaptive response requires what?

A

↑ energy/oxygen consumption

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9
Q

The adaptive response is eventually?

A

Self-destructive

Results in progressive decline in cardiovascular function

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10
Q

Shock syndromes requiring fluid resuscitation?

A
  1. Hypovolemic
  2. Distributive
    ± vasopressors
    ± inotropes
  3. Obstructive
    ± surgery
    ± thrombosis
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11
Q

Which shock type would fluids probably not be helpful?

A

Cardiogenic

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12
Q

Are cats small dogs?

Feline shock patients are different how?

A

NO
Hypothermia and hypotension predominate
Bradycardia rather than tachycardia
Hypothermia - decreases ability to cope with fluid load
Begin resuscitation but do not ‘blast’ a cat with fluids until you determine their response to rewarming

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13
Q

What do you give to ↑ Preload?

What do you give to ↑ SV Afterload?

A

Volume

Vasopressors

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14
Q

What do you give to ↑contractibility?

A

+ Inotropes

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15
Q

Effective fluid resuscitation restores what?

A

tissue perfusion

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16
Q

Total Body Water ___% of BW?

A

60%

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17
Q

Intracellular is ____% of total body water?
% Total Body Weight?

Extracellular Fluid is ___% of total body water?
% Total Body Weight?
• Intravascular is ___% of ECF?
% Total Body Weight?
• Interstitial is ___% of ECF?
% Total Body Weight?

A

Intracellular:
Total Body Water = 66%
Total Body Weight = 40%

Extracellular: 
Total Body Water =33% 
Total Body Weight = 20%
     • Intravascular (ECF):
     % of ECF - Body Water ECF = 25% 
     % of ECF - Body Weight = 4% 
     • Interstitial (ECF)
     % of ECF - Body Water = 75%                      
     % of ECF - Body Weight = 16%
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18
Q

Crystalloids are made of what?

A

salt or sugar solutions of varying concentration

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19
Q

Crystalloid solutions are not restricted by?

Where do they equilibrate between?

A

Endothelium

Interstitial and Intravascular Spaces

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20
Q

Crystalloids have their Primary effect in _____________ space?

A

Interstitial

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21
Q

After 20 - 30 min, how much Crystalloid is still in Intravascular Space?

A

1/3

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22
Q

Osmolality of fluid determines what?

A

Power to draw fluid from interstitial and intracellular spaces

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23
Q

Duration of effect of fluids determined by?

A

Underlying hydration/electrolyte balance

Renal handling of water/electrolytes

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24
Q

Hypertonic saline (5-7%) expands intravascular space by ___ times the volume for short duration?

A

6

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25
Isotonic Crystalloid Behavior: | Distribution to Intravascular and Interstitial Fluids ___% remains in Intravascular Fluid after 20 - 30 min?
25%
26
What are the two conditions you will 1st consider to decide upon which fluids to give? When these conflict how do you decide?
Acid/Base Balance Status Electrolyte Status What are they going to die from first!
27
Which are the Acidifying crystalloids?
0.9% NaCl (Saline)
28
TQ!!! Which are the Alkalinizing solutions? | Which is the MOST alkanizing?
Lactated Ringer's Solution (LRS) | *******Plasmalyte-148 (P-148)/Normosol-R (Norm-R)******
29
TQ!!! What is the most common acid/base disturbance in dogs & cats?
Metabolic Acidosis
30
Saline Advantages? | Disadvantages?
A: Higher Na and Cl Very compatible - no Ca2+ D: Higher Na and Cl Poor buffering ability (bad for acidosis)
31
If a fluid has Ca2+ when can you NEVER use it?
Blood Transfusions
32
LRS Advantages? | Disadvantages?
A: Great buffer for acidic situations More physiologically normal Cl- Buffer ``` D: Ca2+ reactivity Na concentration (low) Lactate (HCO3- precursor) - doesn't seem to matter clinically ```
33
P-148 or Norm-R Advantages? | Disadvantages?
``` A: Increased buffer Non liver buffers Na concentration Mg D: Increased buffer - maybe too buffering ```
34
What are Hypotonic Fluids available? (3) | How often will you give these alone?
Dextrose in Water (D5W) 0.45% NaCl (Half-strength saline) 0.45% NaCl with 2.5% Dextrose VERY RARELY!
35
How does your body handle the dextrose?
Metabolizes the dextrose, essentially giving free water
36
Hypotonic Effect: What is the danger in giving free water?
Electrolyte imbalance/Osmolality issues Cell death Cerebral edema
37
Should D5W be used as a 1º fluid? | How will it most often be used?
NOPE | As fluid for dilution of medications or other fluids
38
Half-strength Saline Indications? | Complication?
Hypernatremia therapy Correct slowly (if chronic) 0.5 mEq/L/hr Complication: Cerebral edema
39
Patients with Na intolerance?
Heart disease End stage renal disease End stage liver disease
40
Colloids are solutions with large macromolecules, movement is restricted by?
Healthy Endothelium
41
Primary effect of colloids is?
volume expansion of vascular space
42
Colloid solutions contribute predominantly to ________ pressure?
Oncotic
43
Major volume draws of Colloids?
Colloid Osmotic Pressure (COP)*** (most) Pressure Gibbs-Donan Effect = Negative charges attract Na/H20 - negative charges draw water twd them (minor )
44
Hetastarth has ___ X volume expansion?
1.4 | 100 ml expands to 140 ml
45
Natural Colloids Available?
Natural Plasma Whole Blood 25% Albumin (human) - allergic rxns - not common
46
Synthetic Colloids Available?
Synthetic Dextran 70 (Dex-70) Hetastarch (HES) - most common Pentastarch (PS) Oxyglobin
47
Hetastarch Advantages? | Disadvantages?
``` A: Molecular size Duration of action - works longer Low Reactivity D: Hemostasis effects - coagulopathies due to dilution Cost ```
48
Oxyglobin Advantages:
Doesn't expire quickly Oxygen delivery Volume expansion No immunoreactivity
49
Oxyglobin Disadvantages:
NO scavenging $$$ Duration of effect Potent volume expansion
50
What is important to ALWAYS remember when doing fluid therapy?
Titration to effect | No 2 animals/cases are alike
51
TQ!!! What are the Isotonic Crystalloid shock doses for dog and cat?
``` Dog Dose (mL/kg) = 80-90 Cat Dose (mL/kg) = 40-50 ```
52
TQ!!! What are the Hetastarch (6%) shock doses for dog and cat?
``` K9 Dose (mL/kg) = 20 Fe Dose (mL/kg) = 10-15 ```
53
Total Blood Volume for Dogs? | Cats?
8-9% of BW dog (80-90 mL/kg) | 5-6% of BW cat (50-60 mL/kg)
54
Signs of shock detectable when ____ % blood volume loss?
10-30%
55
Mild signs (compensated shock) __________% loss?
10-15%
56
Moderate signs (early decompensated) _______ loss?
15-30%
57
TQ!!! What is rule for giving shock does?
Give ¼ - 1/3 of shock dose Bolus and then reassess!
58
Developing A Plan: what do you ask first?
Do they need rescuscitation/shock dose?
59
Resuscitation Phase parameters?
``` Pale mm Increased HR/CRT poor pulses cool extremities decreased mentation ```
60
Estimating Dehydration: subclinical? Mild? Moderate? Severe?
5-6% subclinical 6-8% mild with no cardiovascular signs 8-10% moderate with minor cardiovascular signs 10-12% severe with signs of hypovolemic shock 12-15% severe, moribund
61
Replace sensible and insensible losses based on? | Alternate method?
Body Mass:Surface Area Use maintenance fluid chart (no chart available): 60 ml/kg/day****
62
Volume of GI losses usually underestimated by?
50%
63
What is normal urine production? | When should urine be considered in ongoing losses?
1-2 ml/kg/hr | >2 mL/kg/hr is ongoing loss
64
TQ!!! Maximum for KCl administration? | Why is it toxic?
0.5 mEq/kg/hr | Potassium affects RESTING potential
65
What does Ca2+ affect?
THRESHOLD potential
66
To correct fluid loss due to dysfunction of preload what should be given?
Volume
67
To correct fluid loss due to dysfunction of contractibility what should be given?
+ Inotrope
68
To correct fluid loss due to dysfunction of afterload what should be given?
Vasopressors
69
Speed of replacement for dehydration? | What is most physiological?
Rapid or over 24hr | slowly
70
What are rehydration needs?
Maintenance Ongoing Losses Deficit
71
Target for shock dose for Crystalloids is to expand blood volume by ____%? Dog = ______mL/kg Cat = ______mL/kg
30% 30 mL/kg DOG 20 mL/kg CAT
72
When giving shock fluids should you think dose or rate?
Dose!
73
Colloid Expanding effect depends on (2)?
1. Intact Endothelium | 2. Presence of interstitial fluid
74
What should you give with colloids to begin tx of dehydration and allow optimal performance of colloid?
Give concurrent crystalloids!

Clinical Medicine Master (17 decks)

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