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Plunkett Emergency > Shock > Flashcards

Shock Flashcards

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1
Q

What is shock?

A

Decreased flow of oxygen to tissues, thereby causing a decreased use of oxygen by tissues

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2
Q

What three mechanisms cause decreased distribution of oxygen to tissues (D02)?

A

Cardiogenic shock
Distributive shock
Hypovolemic shock

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3
Q

What are examples of hypovolemic or circulatory shock?

A

Severe dehydration
Hemorrhage
Trauma

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4
Q

What are examples of cardiogenic shock?

A

Cardiac arrhythmias
Cardiac tamponade
Congestive heart failure
Drug overdose

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5
Q

What are examples of distributive shock?

A

Anaphylaxis
Obstruction (thrombus, heartworm, etc.)
Sepsis

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6
Q

What are examples of hypoxemic shock?

A

Anemia
Carbon monoxide toxicity
Methomeglobinemia
Pulmonary disease

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7
Q

What are examples of metabolic shock?

A

Cyanide intoxication
Cytopathic hypoxia secondary to sepsis
Hypoglycemia

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8
Q

What clinical signs are noted with hyperdynamic/ compensatory phase of shock?

A 
Elevated or normal HR
Elevated or normal RR
Injected/ hyperemic MM
Rapid CRT (< 1 sec)
Bounding or normal peripheral pulses
Increased/ normal blood pressure

Cats have slight different signs:
Pale MM
Hypothermic and cool extremities
Generalized weakness

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9
Q

What clinical signs are noted with hypodynamic/ early decompensatory phase of shock?

A 
Hypothermia
Poor peripheral pulse quality
Pale MM
Normal/ decreased blood pressure
Prolonged CRT
Tachycardia 
Oliguria
Dull mentation
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10
Q

What clinical signs are noted with terminal/ late decompensatory phase of shock?

A 
Stupor/ coma
Hypothermia
Bradycardia
Weak/ peripheral pulses
Pale/ cyanotic MM
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11
Q

What mean blood pressure do want to keep above during shock

A

> 65 mmHg

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12
Q

What should minimum urine output be?

A

> 1-2 mL/kg/day

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13
Q

What is the first goal of therapy for shock?

A

Restoring the circulatory system and supportive to cardiac system with IV fluids

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14
Q

What should blood lactate levels be normally? When is this a poor prognostic indicator?

A

Normal: < 2.5

Poor prognosis: > 7.0

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15
Q

When should plasma be administered to patients?

A

When a coagulopathy is present

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16
Q

When should whole blood be administered to patients?

A

When anemia is present

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17
Q

What are physical exam signs of cardiogenic shock?

A 
Respiratory distress
Tachycardia
Hypothermia
Heart murmur
Gallop rhythm
Jugular distension
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18
Q

What is urticaria?

A

Superficial skin allergic reaction resulting in wheals

19
Q

What is angioedema?

A

Deep inflammation of blood vessels resulting in edema and localized swelling

20
Q

What is anaphylaxis?

A

A severe allergic reaction occurring 30 minutes after an insult
Patients should be monitored 12-24 hours after event

21
Q

What is the main shock organ in dogs? What are common clinical signs of anaphylaxis in dogs?

A 
Liver is shock organ
Excitability
Vomiting
Defecation
Urination 
Respiratory depression
Collapse
Peracute death
22
Q

What is the main shock organ in cats? What are common clinical signs of anaphylaxis in cats?

A 
Respiratory and GI tracts
Facial pruritus
Hypersalivation
Ataxia 
Dyspnea
Vomiting 
Diarrhea
Collapse
Peracute death
23
Q

What insects can cause anaphylaxis?

A 
Bees
Hornets 
Wasps
Yellow jackets
Ants
24
Q

What medicines can cause anaphylaxis?

A

Vaccines
Antibiotics (penicillins, sulfa, BNP in cats)
Food allergies
Contact Allergies

25
Q

What lab values abnormalities are noted with anaphylaxis?

A

CBC:
Elevate PCV
Inflammatory leukogram
Elevated ALT, bilirubin ALP

26
Q

What values are noted with acute renal failure secondary to anaphylaxis?

A

Elevated BUN and creatinine

Granular casts in urine

27
Q

When is fluid administration recommended with shock?

A

When PCV > 55 or if patient is frequently V/D

28
Q

What should be administered to dyspenic patients secondary to anaphylaxis?

A

Oxygen therapy and aminophylline

29
Q

What are causes of septic shock or systemic inflammatory response syndrome (SIRS)?

A 
Any infection in any part of the body
Heat stroke
Trauma
Snake envenomation
Bite wounds
Neoplasia
Pancreatitis
30
Q

What are criteria needed to considered for a DOG to be in SIRS?

A 
Needs at least two of the following:
Heart rate:  > 120
Resp rate: >20
Body temperature: < 100.6 or >102.6
WBC count: < 6 or > 16 (bands > 3%)
31
Q

What are criteria needed to considered for a CAT to be in SIRS?

A 
Needs at least three of the following:
Heart rate:  < 140 or > 223
Resp rate: >40
Body temperature: < 100 or >104
WBC count: < 5 or > 19
32
Q

What are the major septic foci in the body?

A 
Abdominal cavity (septic peritonitis)
GI tract (bacteremia, translocation)
Repro tract (pyometra, prostatis)
Urinary tract (pyelonephritis)
Resp tract (pneumonia)
Thoracic cavity (pyothorax)
Heart valves (endocarditis)
Teeth/ periodontal tissues (periodontitis, oral abscess)
Skin (bite wounds, cellulitis)
Bones, joints (osteomyelitis, septic arthritis)
33
Q

What condition can follow SIRS and shock?

A

Multiorgan dysfunction syndrome (MODS)

34
Q

What electrolyre can be affected with shock?

A

Magnesium, supplement when < 0.7

35
Q

What blood glucose value difference indicates suspicion of septic peritonitis?

A

Peritoneal fluid blood glucose > 20 less than blood glucose

36
Q

How long should antibiotic cultures be held in patients that are currently on antibiotics?

A

14 days

37
Q

What is the prognosis for patients with early signs of shock (injected MM, tachycardia, bounding pulses)

A

Fair to guarded prognosis

38
Q

What is the prognosis for patients with signs of septic shock (cyanotic/ muddy pink/ gray/ pale MM, prolonged CRT, weak pulses)

A

Guarded to poor prognosis

39
Q

When placing a dog on IV aminoglycosides, what lab parameter should be measured every day?

A

Urine sediment for casts and cellular debris

40
Q

When should you consider changing antibiotic therapies in dogs with shock?

A

If no significant changes are noted in 36-48 hours

41
Q

What is the minimum PCV value that should be maintained?

A

At least 21%

42
Q

Why should you monitor magnesium levels along with potassium?

A

Magnesium reduces the loss of potassium

43
Q

What should be administered if a patient becomes oliguric secondary to shock?

A

Mannitol or furosemide

44
Q

If a patient appears depressed while being treated for shock, what values should be checked?

A

Blood glucose and serume osmolality?

Plunkett Emergency (8 decks)

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