Shock Flashcards
Shock
Defined as cellular hypoxai
4 catgories of shock
1 Cardiogenic shock
2 Distructive Shock
3 Obstructive shock
4 Hypovolaemic shock
Cardiogenic Shock
inneffective forward blood flow, poor tissue persusion and O2 delivery
Disruptive shock
occurs when blood vessels expand vasodilate and normal volume of blood not sufficient to fill the vessels
Obstructive shock
mechanical obstructions of the vessels eg GDV
Hypovolaemic shock
loss of circulating blood volume
how to recognise shock
1 mentation 2 MM colour 3 CRT 4 HR 5 Pulse quality 6 extremity Temp.
MM colour pale/white
cause of vasoconstriction
MM colour bright pink or red
cause of vaso dilation
Decompensation shock
when the heart rate is slow or normal when all other pareters are normal
A palpable femoral pulse is consistant with what systolic blood pressure
greater than 60 mmHg
A palpable doral metatarsal pulse is consitant with what systolic blood pressure
greater than 90 mmHg
extremity temp.
usualy 4 degrees lower thant the core temperature
3 stages of shock (dogs)
1 compensatory shock
2 early decompensatory
3 late decompensatory
Compensatory shock signs
tachycardia, bounding pulses, CRT < or equal to 1 sec, normal to increased arterial blood pressure, normal mentation
early decompensatory shock signs
tachycardia, weak or absent pulses, pale MM, Prolonged CRT, hypotension, depression, ddecreased body temp.
Late decompensatory shock signs
normal to decreased HR, white MM, very slow or absent CRT, no peripheral pulses, hypotension, decreased level of consciousness
what is increased lactate levels in the blood a sign of
poor perfusion
emergency stabilisation of shock
1 Oyygen supplemtation 2 Secure IV access 3 start crystalloid fluids 4 add colloids hypertonic saline 5 vasopressor 6 analgesia
what size catheter should you use
ideally a 16gague, or a 22-18 gaugue catheter at first and then switch to bgger gauge when veins improve
what type of shock should you not give fluids to
cardiogenic shock
what is the total blood volume of a dog
80-90ml/kg
what is the total blood volume of a cat
60 ml/kg
what is the goal or end point when treating shock patients
normal perfusion parameters
fluid resucitation rate for a dog
1/4 of the calculated shock dose as a bolus 22.5ml/kg given over 15 mins, checked every 5 mins oof perfusion parameters
fluid resucitation rate for a cat
1/4 of the calculated shock dose as a bolus 10-15ml/kg given over 15mins and checked every 5 mins for perfusion parameters
what is a standard crystalloid shock dose for dog
one complete blood volume (80-90ml/kg)
what is the standard crystalloid shock dose for a cat
one complete blood volume 50-55 ml/kg
how long should you replace the calculated deficits after the shock has been stabilised
over 6-8 hrs depeding on comorbidities
what to do if 50% of the calculated shock volume of isotonic crystalloid has not caused any improvement
either switch to a colloid or add colloids to the isotonic fluids
what does giving hypertonic saline cause
fluid to shift from IC space to the EC space which causes improved venous return and cardiac output
what volume of colloids stays in the intravascular space
50-80% of infused colloid
what is the shock dose of colloids for dogs
5ml/kg bolus over 10 mins
what is the shock dose of colloids for cats
2.5ml/kg bolus over 10mins
when to administer colloids
when increased tissue perfusion and O2 delivery needed
if oedema develops prior to adequate blood volume restoration
when total protein is 35g/L or albumen is 15g/L
when should you administer vasopressors
when patient is unresponsive to fluid therapy
what analgesia drugs should you avoid during resuscitation
non steroiddal anti-inflammatories
alpa 2 agonists
