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Y3 SPRING > SA MED - ECC Fluid Therapy > Flashcards

SA MED - ECC Fluid Therapy Flashcards

1
Q

Why do colloid fluids remain in the vascular space longer?

A

They contain large molecular substances

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2
Q

How do colloid fluids draw water into the intravascular space?

A

Colloids pull fluid from interstitial space via oncotic properties

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3
Q

What is the effect of colloids on total blood volume?

A

Total blood volume increases

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4
Q

________ are more effective than crystalloids in increasing intravascular volume.

A

Colloids

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5
Q

Synthetic colloids increase intravascular volume by _____ than the volume infused.

A

More

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6
Q

Why use colloids?

To improve ______
To maintain ______

A

Improve intravascular volume - hypovolemia, hypotension tx

Maintain intravascular colloid osmotic pressure - minimizes tissue edema

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7
Q

Three types of colloid fluid solutions

A

Synthetic - VetStarch, Hetastarch
Natural - plasma, albumin
O2 carrying solution - whole blood, PRBCs

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8
Q

VetStarch and Hetastarch are also known as ____ starch solutions

A

Hydroxyethyl starch solutions

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9
Q

Hydroxyethyl starch solutions have a structure similar to _____

A

Glycogen

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10
Q

The elimination half-life of Hydroxyethyl starch solutions is determined by these three things:

A

Molar substitution
C2:C6 substitution ratio
Molecular weight

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11
Q

Volume expansion of Hydroxyethyl starch solutions is determined by ___.

A

Solution concentration

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12
Q

Coagulopathy of Hydroxyethyl starch solutions is determined by _____ and _____.

A

Molecular weight and molar substitution

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13
Q

Duration of Hetastarch vs VetStarch

A

Hetastarch 24-36 hours
VetStarch 4-6 hours

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14
Q

Hydroxyethyl starch solutions:

Recommended dosage for dogs vs cats

A

Dogs: 20 mL/kg/day
Cats: 10-20 mL/kg/day

Bolus
Dogs: 5 mL/kg
Cats: 2.5-5 mL/kg

24-hr CRI

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15
Q

Hydroxyethyl starch solution side effects (3)

A

Allergic reactions
Induced coagulopathies
Acute kidney injury

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16
Q

How is plasma obtained?

A

Plasma is obtained after removing RBCs from whole blood by centrifugation

17
Q

What does plasma provide?

A

Proteins - albumin, globulin, fibrinogen
Coagulation factors
Immunoglobulins

18
Q

What is the recommended dosage fro plasma?
What is the effect on total protein and coagulation factors?

A

20 mL/kg
TP increases by 1 g/dL
Coagulation factors increased by 40%

19
Q

Fill in the natural colloids chart

A
20
Q

When are packed red blood cells indicated?

A

Anemia with normal protein concentrations and normal coagulation status

21
Q

____ mL/kg packed red blood cells raises the PCV by 1%.

A

1.5 mL/kg

22
Q

How much will the PCV increase in a 30 kg dog given 1 unit of packed red blood cells (225 mL)?

A

5% (?)

23
Q

When is the use of fresh/stored whole blood indicated?

A

Anemia with hypoproteinemia AND/OR coagulopathy (factor or platelet deficiency)

24
Q

What dosage of whole blood raises the PCV by 1%?

A

2.2 mL/kg

25
Q

How much will the PCV increase in a 5kg cat given 1 unit of whole blood (60 mL)?

A

5.5% ?????

26
Q

Considerations when choosing fluids to treat shock

A

Pathophysiology
Type of fluid defecit
Microvascular integrity
Colloid oncotic pressure
Properties of the fluid

27
Q

Four types of shock

A

Hypovolemic - inadequate circulating blood volume

Distributive - maldistribution of blood flow and volume

Obstructive - extracardiac obstruction of blood flow

Cardiogenic - primary pump failure

28
Q

Complete the algorithm

A
29
Q

Chip, a 3YO MN Lab has a history of four days of vomiting and diarrhea. On physical exam, he is quiet, depressed, and 12% dehydrated. Temp is 98.3 F, Pulse 200 bpm, Respiration 48 bpm, blood pressure 60 mmHG. He has pale mucous membranes with CRT 3 seconds.
PCV 57%
TS 8.4
Blood glucose 89
Lactate 5.6

What type of shock is most likely?

A

Nontraumatic hypovolemic shock

30
Q

Chip, a 3YO MN Lab has a history of four days of vomiting and diarrhea. On physical exam, he is quiet, depressed, and 12% dehydrated. Temp is 98.3 F, Pulse 200 bpm, Respiration 48 bpm, blood pressure 60 mmHG. He has pale mucous membranes with CRT 3 seconds.
PCV 57%
TS 8.4
Blood glucose 89
Lactate 5.6

Fluid defecit: intravascular
Path: decreased blood volume with concurrent dehydration
Microvascular perm: normal
Plasma oncotic pressure: normal

Which fluid are you going to use to treat Chip’s shock?

Plasma-Lyte
7.5% NaCl
VetStarch
0.45% NaCl

A

Dehydration —> interstitial loss
Chronic dehydration —> + intracellular loss

Plasma-Lyte - isotonic crystalloid
- 25% stays in vascular space; 75% redistributes from vascular to interstitial space
- OK to start with but may need to change at some point

7.5% NaCl - hypertonic saline
- pulls fluid from interstitial and intracellular spaces
- NO bc will deplete compartments already dehydrated

VetStarch - synthetic colloid
- pulls fluid from interstitial space
- NO bc interstitial space already depleted

0.45% NaCl - hypotonic crystalloid
- NOT used to treat shock
- good for replenishing interstitial and intracellular dehydration LATER

31
Q

Tank, a 5YO MN Pug HBC 3 hours ago presents with epistaxis and bruising over abdomen and thorax. On physical exam, Tank is dull and unresponsive with normal hydration. Temp 99.8 F, Pulse 220 bpm, Resp 56 bpm, BP 50 mmHg. Tank has pale MM and CRT > 3 seconds.
PCV 35%
TS 4.8
Blood glucose 176
Lactate 6.8

What type of shock is most likely?

A

Traumatic hypovolemic shock

32
Q

Tank, a 5YO MN Pug HBC 3 hours ago presents with epistaxis and bruising over abdomen and thorax. On physical exam, Tank is dull and unresponsive with normal hydration. Temp 99.8 F, Pulse 220 bpm, Resp 56 bpm, BP 50 mmHg. Tank has pale MM and CRT > 3 seconds.
PCV 35%
TS 4.8
Blood glucose 176
Lactate 6.8

What are the properties of Tank’s traumatic hypovolemic shock?

Fluid deficit:
Pathophysiology:
Microvascular permeability:
Plasma oncotic pressure:

A

Fluid deficit: intravascular
Pathophysiology: decreased blood volume
Microvascular permeability: normal to increased
Plasma oncotic pressure: normal to decreased

33
Q

Tank, a 5YO MN Pug HBC 3 hours ago presents with epistaxis and bruising over abdomen and thorax. On physical exam, Tank is dull and unresponsive with normal hydration. Temp 99.8 F, Pulse 220 bpm, Resp 56 bpm, BP 50 mmHg. Tank has pale MM and CRT > 3 seconds.
PCV 35%
TS 4.8
Blood glucose 176
Lactate 6.8

Which fluid are you INITIALLY going to use to treat Tank’s shock?

Plasma-Lyte
7.5% NaCl
VetStarch
Packed RBCs

A

Not dealing with dehydration, so don’t have to worry about interstitial and intracellular spaces

Plasma-Lyte - isotonic crystalloid
- 25% stays in vascular space, 75% redistributes to interstitial space
- Tank is bleeding, a little anemic, protein a little low so have to be mindful of how much Plasma-Lyte administered
- OK if use a volume-limited approach until we know Tank is not still hemorrhaging
- avoid BP > 100 mmHg to avoid promoting hemorrhage
- recommend 1/4 shock dose over 30 minutes instead of full dose over 15 minutes

7.5% NaCl - hypertonic saline
- pulls fluid from interstitial and intracellular spaces
- OK since patient has normal hydration
- can also be used to treat increased intracranial pressure if concerned about mentation (instead of or in addition to mannitol)

VetStarch - synthetic colloid
- pulls fluid from interstitial space
- OKish because normal hydration and not in septic shock
- can cause hypocoagulability

Packed RBCs
- NO for initial treatment as cannot administer quickly enough to resolve shock
- must give slowly (over 2-4 hours) and monitor for signs of transfusion reaction
- can use later if needed

34
Q

Murphy, a 6MO MI lab has a history of two days of vomiting and bloody diarrhea. On physical exam, Murphy is depressed and >12% dehydrated. Temp 97.2 F, Pulse 210 bpm, Resp 50 bpm, BP unobtainable. Murphy has pale MM and a CRT of 4 seconds.
PCV 40%
TS 6.2
Blood glucose 46
Lactate 7.8
Parvo + with rare WBCs on blood smear

What kind of shock is most likely?

A

Septic shock

35
Q

Murphy, a 6MO MI lab has a history of two days of vomiting and bloody diarrhea. On physical exam, Murphy is depressed and >12% dehydrated. Temp 97.2 F, Pulse 210 bpm, Resp 50 bpm, BP unobtainable. Murphy has pale MM and a CRT of 4 seconds.
PCV 40%
TS 6.2
Blood glucose 46
Lactate 7.8
Parvo + with rare WBCs on blood smear

Properties of Murphy’s septic shock -

Fluid deficit:
Pathophysiology:
Microvascular permeability:
Plasma Oncotic Pressure:

A

Fluid deficit: relative depletion
Pathophysiology: maldistribution of blood flow
Microvascular permeabiliity: increased
Plasma oncotic pressure: decreased

36
Q

Murphy, a 6MO MI lab has a history of two days of vomiting and bloody diarrhea. On physical exam, Murphy is depressed and >12% dehydrated. Temp 97.2 F, Pulse 210 bpm, Resp 50 bpm, BP unobtainable. Murphy has pale MM and a CRT of 4 seconds.
PCV 40%
TS 6.2
Blood glucose 46
Lactate 7.8
Parvo + with rare WBCs on blood smear

Which fluid are you INITIALLY going to use to treat Murphy’s shock?
Plasma-Leyte
7.5% NaCl
VetStarch
0.45% NaCl & 2.5% Dextrose

A

Plasma-lyte - isotonic crystalloid
- 25% stays in vascular space, 75% redistributes to interstitial space
- OK to start tx with this patient who is shocky and dehydrated

7.5% NaCl - Hypertonic saline
- might help with septic shock, but have concurrent dehydration so contraindicated

0.45% NaCl + 2.5% dextrose - hypotonic saline and dextrose
- bag says isotonic because dextrose adds tonicity, but dextrose metabolizes to CO2 and water (hypotonic)
- NO bc in the body, this mix is hypotonic

  • 0.9% NaCl + dextrose would be ok to use (isotonic saline and dextrose)

Y3 SPRING (40 decks)

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