Small animal triage and shock

Question 1

What is the goal of a primary survey

Answer 1

Stabilising the patient

Question 2

What does ABCDE in primary survery mean

Answer 2

Airway
Breathing
Circulation
Demeanour
Entire body

Question 3

Define Circulatory shock

Answer 3

A global energy deficit at a cellular level

Question 4

What are the 3 types of circulatory shock

Answer 4

Hypovolaemic, Cardiogenic, Distributive

Question 5

What are the 3 types of shock

Answer 5

Circulatory, Hypoxic, Metabolic

Question 6

What causes hypovolaemic shock

Answer 6

Results from loss of intravascular volume
Dehydration (severe)
Blood loss

Question 7

What causes Cardiogenic Shock

Answer 7

Heart disease
Cardiac tamponade
Arrhythmias

Question 8

Why must cardiogenic shock be differentiated from other types of shock

Answer 8

large volume fluid administration is contra-indicated

Question 9

What is distributive shock

Answer 9

Cardiac function and blood volume are not affected but there is a failure of the vascular tree to allow appropriate delivery

Question 10

What causes distributive shock

Answer 10

Loss of vascular tone
- Sepsis/Endotoxaemia
- Anaphylaxis
Venous blockage of blood (Obstructive Shock)
- GDV
- Pulmonary thromboembolism

Question 11

Clinical signs of Classic hypovolaemic Shock

Answer 11

Tachycardia as part of the sympathetic response
Poor pulse quality due to vasoconstriction and lack of blood volume
Decreased extremity temperature
Pale mucous membranes
Prolonged capillary refill time
Decreased mentation due to inadequate brain perfusion
Tachypnoea to increase oxygen uptake (not always evident)

Question 12

What is the HR of a dog experiencing severe hypovolaemia

Answer 12

170-200

Question 13

T/F Dogs may have increased heart rates in early shock but frequently present with bradycardia in more severe shock

Answer 13

False! Cats not dogs

Question 14

What is the significance of Gastrointestinal Hypoperfusion & Inflammation

Answer 14

Sympathetic activation tends to shunt blood away from the GIT
Dispropotionate hypoperfusion and inflammation
May amplify SIRS
May allow bacterial translocation causing sepsis

Question 15

What is SIRS

Answer 15

Systemic inflammatory response syndrome
A complex immune response follows involving activation of multiple inflammatory mediators throughout the body

Question 16

Aims of shock treatment

Answer 16

1. Rapid yet judicious use of fluid therapy to restore vascular volume, normalise tissue perfusion and reduce secondary injuries
2. Reduce morbidity and mortality
3. Identification and control of any haemorrhage

Question 17

What route of fluid administration is suited for puppies and kittens

Answer 17

Intra-osseous cannulation

Question 18

What is the dosage of isotonic crystalloid given initially in goal directed therapy

Answer 18

10-20ml/kg of isotonic crystalloid over 15 minutes and then reassess perfusion parameters; particularly an improvement in mentation, a decrease in heart rate and improving pulse quality

Question 19

Name 3 isotonic crystalloids

Answer 19

Saline
Hartmanm
Ringer

Question 20

Why do we use harmanns for fluid therapy

Answer 20

It is akalinising and shock patients have a metabolic acidosis (lactic)

Question 21

Hartmanns contraindicaitons

Answer 21

Lactate cannot be metabolised in SEVERE liver disease
Low osmolarity, therefore not suitable where fluid accumulation may be an issue
Contains calcium Cannot be mixed with blood products

Question 22

Which situations are Colloids more useful over crystalloids

Answer 22

Hypoalbuminaemia
Large patients
Poor response to crystalloids

Question 23

When do we use hypertonic saline as fluid therapy

Answer 23

hypovolaemic patients with head trauma

Question 24

What is the blood volume of a dog

Answer 24

90ml/kg