Small animal triage and shock Flashcards
What is the goal of a primary survey
Stabilising the patient
What does ABCDE in primary survery mean
Airway
Breathing
Circulation
Demeanour
Entire body
Define Circulatory shock
A global energy deficit at a cellular level
What are the 3 types of circulatory shock
Hypovolaemic, Cardiogenic, Distributive
What are the 3 types of shock
Circulatory, Hypoxic, Metabolic
What causes hypovolaemic shock
Results from loss of intravascular volume
Dehydration (severe)
Blood loss
What causes Cardiogenic Shock
Heart disease
Cardiac tamponade
Arrhythmias
Why must cardiogenic shock be differentiated from other types of shock
large volume fluid administration is contra-indicated
What is distributive shock
Cardiac function and blood volume are not affected but there is a failure of the vascular tree to allow appropriate delivery
What causes distributive shock
Loss of vascular tone
- Sepsis/Endotoxaemia
- Anaphylaxis
Venous blockage of blood (Obstructive Shock)
- GDV
- Pulmonary thromboembolism
Clinical signs of Classic hypovolaemic Shock
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)
What is the HR of a dog experiencing severe hypovolaemia
170-200
T/F Dogs may have increased heart rates in early shock but frequently present with bradycardia in more severe shock
False! Cats not dogs
What is the significance of Gastrointestinal Hypoperfusion & Inflammation
Sympathetic activation tends to shunt blood away from the GIT
Dispropotionate hypoperfusion and inflammation
May amplify SIRS
May allow bacterial translocation causing sepsis
What is SIRS
Systemic inflammatory response syndrome
A complex immune response follows involving activation of multiple inflammatory mediators throughout the body
Aims of shock treatment
- Rapid yet judicious use of fluid therapy to restore vascular volume, normalise tissue perfusion and reduce secondary injuries
- Reduce morbidity and mortality
- Identification and control of any haemorrhage
What route of fluid administration is suited for puppies and kittens
Intra-osseous cannulation
What is the dosage of isotonic crystalloid given initially in goal directed therapy
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
Name 3 isotonic crystalloids
Saline
Hartmanm
Ringer
Why do we use harmanns for fluid therapy
It is akalinising and shock patients have a metabolic acidosis (lactic)
Hartmanns contraindicaitons
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
Which situations are Colloids more useful over crystalloids
Hypoalbuminaemia
Large patients
Poor response to crystalloids
When do we use hypertonic saline as fluid therapy
hypovolaemic patients with head trauma
What is the blood volume of a dog
90ml/kg
