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VET433: ECC & Toxicology > Shock > Flashcards

Shock Flashcards

1
Q

shock

A

inadequate cellular energy production

occurs when oxygen delivery does not equal oxygen consumption

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2
Q

three mechanisms of shock

A
  1. inadequate blood flow to cells
  2. lack of substrate
  3. cellular dysfunction
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3
Q

types of shock - inadequate blood flow to cells

A

most common
diagnosed by PERFUSION PARAMETERS

  1. vasoconstrictive - hypovolemic, obstructive, cardiogenic
  2. vasodilatory - distributive
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4
Q

types of shock - lack of substrate & cellular dysfunction

A

less common
diagnosed by LAB VALUES

  1. metabolic shock - hypoglycemia, hypoxemic, cytopathic
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5
Q

perfusion parameters

A
  1. mentation
  2. MM color
  3. CRT
  4. HR
  5. pulse quality
  6. extremity temperature
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6
Q

vasoconstrictive shock - PP

A
  1. obtunded mentation
  2. pale MM
  3. slow CRT (>2s)
  4. tachycardia (dogs), bradycardia (cats)
  5. poor pulse quality
  6. cold extremities
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7
Q

types of vasoconstrictive shock

A
  1. hypovolemic
  2. obstructive
  3. cardiogenic
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8
Q

hypovolemic shock

A

decreased circulating volume

causes dec. preload –> dec. stroke volume + cardiac output –> dec. O2 delivery and BP

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9
Q

causes of hypovolemic shock

A

intravascular volume loss
1. whole blood: hemorrhage (internal or external)
2. plasma loss: GI loss of plasma proteins
3. isotonic loss: GI (vomiting, diarrhea), renal, burns, third space loss

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10
Q

obstructive shock

A

relative hypovolemia
normal blood volume but not enough is returning to the heart

causes dec. preload –> dec. SV and CO –> dec. O2 delivery and BP

**dec. preload caused by obstruction of blood flow back to heart NOT by low volume

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11
Q

causes of obstructive shock

A
  1. pericardial effusion
  2. GDV
  3. space occupying lesions
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12
Q

cardiogenic shock

A

heart disease leading to inadequate circulation

dec. preload and contractility w/ inc. afterload –> dec. SV and HR –> dec. CO –> dec. O2 delivery

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13
Q

causes of cardiogenic shock

A

primary heart disease:
1. altered HR: tachy/bradycardia and tachy/bradyarrhythmias
2. decreased preload: degenerative mitral valve disease
3. decreased contractility: DCM, HCM

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14
Q

how to differentiate a hypovolemic or obstructive shock from cardiogenic shock

A
  1. history: hx of fluid loss (hemorrhage, vomiting, diarrhea) vs hx of heart disease
  2. signalment: breed predispositions for heart disease
  3. PE: heart murmurs, arrhythmias, venous distension, dyspnea, cyanosis, pulmonary crackles
  4. additional tests: ECG, POCUS, troponin, NT-proBNP
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15
Q

how does treatment of cardiogenic shock differ from other vasoconstrictive shocks

A

do NOT use IV fluid resuscitation in patients with heart disease

exception: pericardial effusion because it is obstructive shock not cardiogenic

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16
Q

vasodilatory shock - PP

A
  1. obtunded mentation
  2. hyperemic MM
  3. rapid CRT (<1s)
  4. tachycardia
  5. bounding pulses
  6. warm extremities
17
Q

distributive shock

A

decreased systemic vascular resistance

dec. SVR –> dec. venous return –> dec. CO –> dec. O2 delivery

over time - inflammatory mediators can increase vascular permeability leading to decreased preload

18
Q

causes of distributive shock

A
  1. inflammatory mediators
  2. sepsis/SIRS
  3. anaphylactic reactions
19
Q

hypoglycemic and hypoxemic shock

A

substrates are unavailable leading to inadequate cellular energy production

dec. Hb/SaO2/PaO2 –> dec. CaO2 –> dec. O2 delivery

20
Q

causes of hypoglycemia/hypoxemic shock

A
  1. severe hypoglycemia (neonates, sepsis)
  2. hypoxemia (anemia, dyshemoglobinemia, lung disease)
21
Q

cytopathic shock

A

substrates available but cells unable to use it

caused by uncoupling of oxidative phosphorylation

22
Q

shock treatment plan

A
  1. O2 supplementation
  2. IV fluid therapy
  3. active warming (cats only)
23
Q

goal of IV fluid therapy

A

increase preload

use a large bore and short IVC for fluid bolus administration

reassess every 5-10 minutes

24
Q

why do cats need to be actively warmed during fluid resuscitation

A

cats will appear vasoconstricted if hypothermic - can obscure resuscitation status and lead to overestimation of fluid requirements

25
Q

types of fluids

A
  1. isotonic crystalloids - LRS, plasmalyte, 0.9% saline, normosol
  2. hypertonic saline
  3. hypotonic - D5W, sterile water, hypotonic saline
  4. colloids - synthetic, natural
26
Q

shock doses - isotonic crystalloids

A

dogs: 80-90 mL/kg IV
cats: 40-50 mL/kg IV

if mild shock: give 1/4 shock dose over 10 min then reassess

if severe shock: give 1/2 shock dose over 5 min then reassess; anticipate needing full dose

27
Q

indications - hypertonic saline

A
  1. head trauma w/ concurrent shock
  2. giant breeds (low volume resuscitation)
  3. active hemorrhage

small volume required - good for administration but only increases blood volume by small amount
- MUST follow up with isotonic crystalloids to restore blood volume

28
Q

shock dose - hypertonic saline

A

dogs: 4-6 mL/kg IV
cats: 2-3 mL/kg IV

rate: 5 minutes

29
Q

are hypotonic solutions ever used for shock resuscitation

A

NO - will not stay in the IV space

causes hyponatremia –> cerebral edema

30
Q

indications - colloids

A

synthetic: high molecular weight so will stay in the IV space longer and draw water into IV space without fluid redistribution into interstitium

natural: hypovolemia + coagulopathies

31
Q

contraindications - colloids

A

synthetic: may cause coagulopathies and AKI

natural: can get transfusion reactions

32
Q

shock dose - colloids

A

synthetic:
- dogs: 10-20 mL/kg IV
- cats: 5-10 mL/kg IV
- rate: 5-15 min

natural: 10-20 mg/kg IV
- want fresh frozen plasma over whole blood

33
Q

resuscitation endpoints

A
  1. normalization of perfusion parameters
  2. improved BP
  3. normal lactate
  4. increased venous O2
  5. normal urine output
34
Q

general fluid dosing guidelines - isotonic

A

dogs: 100 mg/kg
cats: 50 mg/kg

35
Q

general fluid dosing guidelines - synthetic colloids

A

dogs: 20 mL/kg
cats: 10 mL/kg

36
Q

general fluid dosing guidelines - hypertonic saline

A

dogs: 5 mL/kg
cats: 2.5 mL/kg

VET433: ECC & Toxicology (9 decks)

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