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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
Q

Isotonic Crystalloid Behavior:

Distribution to Intravascular and Interstitial Fluids ___% remains in Intravascular Fluid after 20 - 30 min?

A

25%

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26
Q

What are the two conditions you will 1st consider to decide upon which fluids to give?
When these conflict how do you decide?

A

Acid/Base Balance Status
Electrolyte Status
What are they going to die from first!

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27
Q

Which are the Acidifying crystalloids?

A

0.9% NaCl (Saline)

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28
Q

TQ!!! Which are the Alkalinizing solutions?

Which is the MOST alkanizing?

A

Lactated Ringer’s Solution (LRS)

**Plasmalyte-148 (P-148)/Normosol-R (Norm-R)*

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29
Q

TQ!!! What is the most common acid/base disturbance in dogs & cats?

A

Metabolic Acidosis

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30
Q

Saline Advantages?

Disadvantages?

A

A: Higher Na and Cl
Very compatible - no Ca2+

D: Higher Na and Cl
Poor buffering ability (bad for acidosis)

31
Q

If a fluid has Ca2+ when can you NEVER use it?

A

Blood Transfusions

32
Q

LRS Advantages?

Disadvantages?

A

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
Q

P-148 or Norm-R Advantages?

Disadvantages?

A 
A: Increased buffer   
Non liver buffers   
Na concentration 
Mg  
D: Increased buffer - maybe too buffering
34
Q

What are Hypotonic Fluids available? (3)

How often will you give these alone?

A

Dextrose in Water (D5W)
0.45% NaCl (Half-strength saline)
0.45% NaCl with 2.5%
Dextrose VERY RARELY!

35
Q

How does your body handle the dextrose?

A

Metabolizes the dextrose, essentially giving free water

36
Q

Hypotonic Effect: What is the danger in giving free water?

A

Electrolyte imbalance/Osmolality issues
Cell death
Cerebral edema

37
Q

Should D5W be used as a 1º fluid?

How will it most often be used?

A

NOPE

As fluid for dilution of medications or other fluids

38
Q

Half-strength Saline Indications?

Complication?

A

Hypernatremia therapy
Correct slowly (if chronic) 0.5 mEq/L/hr
Complication: Cerebral edema

39
Q

Patients with Na intolerance?

A

Heart disease
End stage renal disease
End stage liver disease

40
Q

Colloids are solutions with large macromolecules, movement is restricted by?

A

Healthy Endothelium

41
Q

Primary effect of colloids is?

A

volume expansion of vascular space

42
Q

Colloid solutions contribute predominantly to ________ pressure?

A

Oncotic

43
Q

Major volume draws of Colloids?

A

Colloid Osmotic Pressure (COP)*** (most) Pressure
Gibbs-Donan Effect = Negative charges attract Na/H20
- negative charges draw water twd them (minor )

44
Q

Hetastarth has ___ X volume expansion?

A

1.4

100 ml expands to 140 ml

45
Q

Natural Colloids Available?

A

Natural Plasma
Whole Blood 25%
Albumin (human) - allergic rxns - not common

46
Q

Synthetic Colloids Available?

A

Synthetic Dextran 70 (Dex-70)
Hetastarch (HES) - most common
Pentastarch (PS)
Oxyglobin

47
Q

Hetastarch Advantages?

Disadvantages?

A 
A: Molecular size  
Duration of action - works longer 
Low Reactivity  
D: Hemostasis effects - coagulopathies due to dilution  
Cost
48
Q

Oxyglobin Advantages:

A

Doesn’t expire quickly
Oxygen delivery
Volume expansion
No immunoreactivity

49
Q

Oxyglobin Disadvantages:

A

NO scavenging $$$
Duration of effect
Potent volume expansion

50
Q

What is important to ALWAYS remember when doing fluid therapy?

A

Titration to effect

No 2 animals/cases are alike

51
Q

TQ!!! What are the Isotonic Crystalloid shock doses for dog and cat?

A 
Dog Dose (mL/kg) = 80-90  
Cat Dose (mL/kg) = 40-50
52
Q

TQ!!! What are the Hetastarch (6%) shock doses for dog and cat?

A 
K9 Dose (mL/kg) = 20  
Fe Dose (mL/kg) = 10-15
53
Q

Total Blood Volume for Dogs?

Cats?

A

8-9% of BW dog (80-90 mL/kg)

5-6% of BW cat (50-60 mL/kg)

54
Q

Signs of shock detectable when ____ % blood volume loss?

A

10-30%

55
Q

Mild signs (compensated shock) __________% loss?

A

10-15%

56
Q

Moderate signs (early decompensated) _______ loss?

A

15-30%

57
Q

TQ!!! What is rule for giving shock does?

A

Give ¼ - 1/3 of shock dose Bolus and then reassess!

58
Q

Developing A Plan: what do you ask first?

A

Do they need rescuscitation/shock dose?

59
Q

Resuscitation Phase parameters?

A 
Pale mm
Increased HR/CRT
poor pulses
cool extremities
decreased mentation
60
Q

Estimating Dehydration: subclinical?
Mild?
Moderate?
Severe?

A

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
Q

Replace sensible and insensible losses based on?

Alternate method?

A

Body Mass:Surface Area
Use maintenance fluid chart
(no chart available): 60 ml/kg/day**

62
Q

Volume of GI losses usually underestimated by?

A

50%

63
Q

What is normal urine production?

When should urine be considered in ongoing losses?

A

1-2 ml/kg/hr

>2 mL/kg/hr is ongoing loss

64
Q

TQ!!! Maximum for KCl administration?

Why is it toxic?

A

0.5 mEq/kg/hr

Potassium affects RESTING potential

65
Q

What does Ca2+ affect?

A

THRESHOLD potential

66
Q

To correct fluid loss due to dysfunction of preload what should be given?

A

Volume

67
Q

To correct fluid loss due to dysfunction of contractibility what should be given?

A

+ Inotrope

68
Q

To correct fluid loss due to dysfunction of afterload what should be given?

A

Vasopressors

69
Q

Speed of replacement for dehydration?

What is most physiological?

A

Rapid or over 24hr

slowly

70
Q

What are rehydration needs?

A

Maintenance
Ongoing Losses
Deficit

71
Q

Target for shock dose for Crystalloids is to expand blood volume by ____%?
Dog = ______mL/kg
Cat = ______mL/kg

A

30%
30 mL/kg DOG
20 mL/kg CAT

72
Q

When giving shock fluids should you think dose or rate?

A

Dose!

73
Q

Colloid Expanding effect depends on (2)?

A
  1. Intact Endothelium

2. Presence of interstitial fluid

74
Q

What should you give with colloids to begin tx of dehydration and allow optimal performance of colloid?

A

Give concurrent crystalloids!

Clinical Medicine Master (17 decks)

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