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Plunkett Emergency > Supportive Therapy > Flashcards

Supportive Therapy Flashcards

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1
Q

What is respiratory acidosis and what lab values are noted with this?

A
  • Indicates hypoxema or hypoventilation
  • Decreased blood pH
  • Increased PaC02
  • Increasead H30- with compensation
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2
Q

What physical exam findings and physiologic events occur with moderately elevated PaCo2

A
  • PE: increasd cardiac output with possible tachyarrhythmias

- Increased intracranial pressure and cerebral blood flow

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3
Q

What occurs at very high levels of respiratory acidosis? What numbers indicate this?

A
  • PaCO2 60- 70 mmHg

- Narcosis, disorienation, coma noted

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4
Q

What are causes of respiratory acidosis?

A
  • Depression of respiratory center - anesthetics, barbituates, opioids
  • Neurologic disease - cervical spinal cord lesion, brainstem lesion
  • Neuromuscular dz: myasthenia gravis, botulism, tetanus, tick paralysis, severe hypokalemia, organophosphates, aminoglycosides
  • Large airway obstruction: aspiration, kinked ET tube, tracheal collapse, brachycephalic airway syndrom, LarPar, mass lesion (intra vs extraluminal), infiltrative airway disease (COPD, astha)
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5
Q

How do you treat respiratory acidosis?

A

Treat underlying cause, ventilation, oxygenation

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6
Q

What is the normal dog arterial blood pH? PaCO2? HCO3 ?P02?

A

PaCO2: 7.41 (7.35 - 7.46)
pH: 37 ( 31 - 43)
HCO3: 22 (19-26)
P02: 92 (81 - 103)

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7
Q

What is the normal cat arterial blood pH? PaCO2? HCO3? P02?

A

PaCO2: 7.39 (7.35 - 7.46)
pH: 31 (25 - 37)
HCO3: 18 (14-22)
P02: 107 (95 - 118)

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8
Q

What changes to the pH, PaC02, and HC03 are noted with respiratory acidosis?

A

pH: decrease
PaC02: increase
HC03: increase or normal

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9
Q

What changes to the pH, PaC02, and HC03 are noted with respiratory alkalosis?

A

pH: increase
PaC02: decrease
HC03: decrease or normal

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10
Q

What changes to the pH, PaC02, and HC03 are noted with metabolic acidosis?

A

pH: decreaee
PaC02: decrease
HC03: decrease

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11
Q

What changes to the pH, PaC02, and HC03 are noted with metabolic alkalosis?

A

pH: increase
PaC02: increase
HC03: increase

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12
Q

What causes respiratory alkalosis?

A

Hyperventilation

  • Fear/ anxiety/ pain
  • Decreased partial pressure of oxygen
  • Pulmonary dz (pneumonia, pulmonary edema, pulmonary fibrosis, PTE)
  • Congestive heart failure
  • Severe anemia
  • Severe hypotension
  • CNS disease
  • Nociceptor or pulmonary stretch receptor stimulation
  • Cushing’s
  • Sepsis
  • Heat stroke
  • Liver dz
  • Meds including aminophylline, steroids, salicylates
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13
Q

What blood gas parameters cause vasoconstriction? What can occur secondary to this?

A

PaC02: < 25 mmHg
pH: > 7.6
- Can results in decreased myocardial or cerebellar blood flow

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14
Q

When is a metabolic/ non-respiratory acidosis considered severe?

A

pH < 7.1

HC03 < 8 meq/L

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15
Q

What are causes of metabolic acidosis?

A
  • Organic acidosis (anti-freezes, lactic acidosis, uremia, DKA)
  • Hyponatremia
  • CHF, liver failure
  • Fluid overload
  • Excessive diuretics, Addisonian crisis
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16
Q

When is a metabolic/ non-respiratory alkalosis considered severe?

A

pH < 7.6

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17
Q

What are causes of metabolic alkalosis?

A
  • Hypochloremia (vomiting, diuretics)
  • Chloride-resistance (Hyperaldosternonism, Cushing’s)
  • Hypoalbumenia
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18
Q

What are the 5 causes of hypoxemia?

A
  1. Hypoventilation (CNS disease, neuromuscular dz, medications, chest wall injury, upper airway disease)
  2. Decreased Fi02 (partial pressure of inspired oxygen): high-altitude, poor anesthetic equipment
  3. Ventilation-perfusion (V/Q) mismatch: asthma, bronchitis, COPD, pulmonary embolism
  4. Diffusion impairment: pulmonary interstitial disease, vasculitis, emphysema, pneumonia, pulmonary edema
  5. Right to left shunt:
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19
Q

What is hypoxemia?

A

Inadequate oxygen in red blood cells

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20
Q

What PCV is needed to adequately carry oxygen to cells?

A

30%, although 22-25 % is usually fine in healthy patients

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21
Q

When is a patient considered hypoxemic? When does a patient become cyanotic?

A
  • < 80 mmHG

- Visible cyanosis occurs at < 40 mmHg

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22
Q

What factors can interfere with pulse oximetry and SpO2?

A
  • Hypoxemia
  • Poor perfusion
  • Hypothermia
  • Vasoconstriction
  • Cardiac arrhythmias
  • Increased pigmentation (jaundice does not affect this)
  • Abnormal hemoglobin
  • Movement
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23
Q

What does Sp02 of 98% correlate with? 95%? 90? 85?

A
  • 98%: Pa02 of 100-500 mmHG
  • 95%: PaO2 of 80 mmHg, mild hypoxemia
  • 90%: PaO2 of 60 mmHg, moderate hypoxemia
  • 85%: methomeglobinemia
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24
Q

When should oxygen therapy be instituted?

A
  • When PaO2 is < 60-80 mmHg
  • Spo2 is < 92%
  • When patient is showing signs of hypoxemia
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25
Q

When is a tracheostomy tube indicated?

A
  • Severe upper respiratory obstruction
  • Severe upper respiratory trauma
  • Severe laryngeal paralysis
  • Long-term positive pressure ventilation
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26
Q

When is hyperbaric oxygen indicated?

A
  • Severe burns
  • Osteomyelitis
  • Severe soft tissue infections
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27
Q

What are signs of shock?

A 
Tachycardia
Pale mucous membranes
Weak/ bounding peripheral pulses
Prolonged capillary refill time
Altered mentation
28
Q

Where should you pinch the skin to check for dehydration?

A

Lumbar spine

29
Q

What is the normal PCV range of a dog?

A

38%-55%

Normal TS 6.0-8.0%

30
Q

What is the normal PCV range of a cat?

A

29%-45%

Normal TS 6.0-8.0%

31
Q

What fluids are useful for correcting dehydration? How do they work?

A

Crystalloids: e.g LRS, NaCl, D5W, Normosol

- These fluids replace intracellular (about 75% is absorbed in 30 minutes)

32
Q

What fluids are useful for shock?

A 
Isotonic crystalloids: LRS, NaCl 0.9%, whole blood, synthetic colloids
Hypertonic fluids (these draw fluid from intracellular space into the vascular space) e.g. hypertonic saline 3%, 7.2%, 7.5%, 23% (needs to be diluted)
33
Q

What dose should be used for 7.2% NaCl for dogs? Cats?

A

3-5 mL/ kg for dogs over 10 minutes

2-4 mL/kg for cats over 10 minutes

34
Q

What occurs if hypertonic saline is given too rapidly?

A

Vagal-mediated hypotension and bradycardia

35
Q

What conditions are hypertonic saline indicated for?

A

Shock
Head trauma
Spinal trauma
Circulatory shock

36
Q

When is hypertonic saline contraindicated?

A 
Dehydration
Volume overload
Hypernatremia
Hyperosmolality
Ventricular arrhythmias
Uncontrolled hemorrhage
37
Q

How do colloids control blood pressure

A
  • Cannot be taken up by cells, stay in vasculature, attracts electrolytes, draws in water
  • The number of colloid molecules is more important than the size
38
Q

What are examples of colloids?

A

Natural: whole blood, fresh frozen plasma
Synthetic: Hetastarch, Pentastarch, Dextran 70, Oxyglobin

39
Q

What is the prognostic indicator of severe hypoalbuminemia in humans?

A

Poor

40
Q

What is a shock dose of hetastarch?

A

5 mL/ kg given slowly
Dogs: can give 10-20 mL/kg/day
Cats: can give 10-15 mL/kg/day. Want to give lower dose in case of fluid overload

41
Q

What side-effect has been reported with hetastarch administration?

A
  • Prolonged PTT although this does not trigger any adverse bleeding episodes
42
Q

What is a side-effect of dextran 40?

A

Acute renal failure. Do not use this

43
Q

What side-effect has been reported with dextran 70 administration?

A

Covers platelets and interferes with Von Willebrands and factor VIII

44
Q

What is fresh frozen plasma?

A

Plasma frozen < 8 hours after being drawn and has been frozen < 1 year

45
Q

What is frozen plasma? What are its components?

A

Plasma frozen > 8 hours after being drawn and has been frozen > 1 year and < 5 years
Has factors II, VII, IX, X, and albumin

46
Q

What is a good rule of thumb for volume to give for blood transfusions?

A

1 mL/ lb will increase the PCV by 1%

47
Q

What should be done if a blood transfusion reaction is noted?

A

Stop the transfusion
Administer epinephrine 0.01 - 0.02 mg/kg SQ, IM, or IV
Administer diphenhydramine 0.5 mg/kg IM or IV
Give crystalloids
Give oxygen therapy

48
Q

What sites can be used for intraosseous fluid administrations?

A
  • Proximomedial tibia
  • Tibial tuberosity
  • Trochanteric fossa of femur
  • Wing of ilium
  • Ischium
  • Greater tubercle of humerus
  • Needs local antiseptic and anesthesia
49
Q

What is normal systolic pressure in the dog? Diastolic? Mean?

A

Systolic: 90-140 mmHg
Diastolic: 50-80 mmHg
Mean: 60-100 mmHg

50
Q

What is normal systolic pressure in the cat? Diastolic? Mean?

A

Systolic: 80-140 mmHg
Diastolic: 50-80 mmHg
Mean: 60-100 mmHg

51
Q

What blood pressure value is considered hypotensive? What are causes of this?

A
  • Mean arterial pressure <60 mmHg
  • Hypovolemia
  • Myocardial fibrosis
  • Gastric distension
  • Tachyacrdia
  • Outflow tract obstruction
  • Cardiomyopathy
  • Ventricular arrhythmias
  • Pericardial tamponade
  • PDA
52
Q

What are adverse reactions to hypotension?

A
  • Acute renal failure
  • Arrhythmias
  • Mentation changes
  • Coagulopathies
  • Melena
  • Tachypnea
  • Vomiting
53
Q

What are treatments options for hypotension?

A
  • Fluid therapy initially
  • If no improvement with fluids, add b-agonists, a agonists, or vasopression
  • B-adrenergic agonists include dopamine, dobutamine, epinephrine, isoproterenol, or vasopressin
54
Q

What is hypertension considered? What are differentials?

A
  • Systolic > 160 mmHg, diastolic > 95 mmHg
  • Renal disease
  • Hyperadrenocorticism
  • Pheochromocytoma
  • Hepatic disease
  • Chronic anemia
  • Hyperthyroidism
  • Hyperaldosteronism
  • Diabetes mellitus
  • Polycythemia
55
Q

What are ocular side-effects of hypertension?

A
  • Glaucoma
  • Retinal detachment
  • Hyphema
  • Perivascular edema
  • Acute blindness
56
Q

What is considered a hypertensive emergency? How can you treat this?

A 
- Systolic > 200 mmHg. Treatment aims to decrease pressure by 25% over the first hour and repeat in 2-6 hours
Treatment examples include:
- Fenoldopam
- Enalaprit
- Na Nitroprusside
- Hydralazine
- Amlodipine
- Enalapril
- Benazepril
- Prazosin
- Propanolol
- Spirinolactone
57
Q

What are causes of elevated abdominal pressure?

A
  • Hemoperitoneum
  • Peritonitis
  • Pancreatitis
  • Ruptured urinary bladder
  • Ileus
  • Abdominal mass
  • Urinary obstruction
  • Blunt abdominal trauma
  • Pelvic fracture
58
Q

What are clinical signs of increased abdominal pressure?

A
  • Short, shallow breaths
  • Tense abdomen
  • Decreased urine output
  • Vomiting
  • Obtunded
59
Q

What are the benefits of enteral feeding?

A
  • Maintains GI mucosal integrity
  • Prevents intestinal villous atrophy
  • Decrease risk of bacterial translocation
  • Maintains GI immune function
60
Q

What are daily water requirements?

A

50-100 mL/ kg/ day

61
Q

When is an esophagostomy tube indicated?

A
  • Inappetence
  • Facial trauma
  • Severe dental disease
  • Stomatitis secondary to infection, potpourri oil, alkali ingestion
  • Orofacial/ pharyngeal mass
  • Orofacial surgery
62
Q

What percentage of protein intake should cats and dogs with kidney or heptatic disease be fed?

A

50%

63
Q

What are physiologic signs of pain?

A
  • Salivation
  • Increased respiratory rate
  • Dilated pupils
  • Increased heart rate +/- arrhythmias
  • Increased temperature
64
Q

What are behavioral signs of pain?

A
  • Increased aggression
  • Restlessness
  • Trembling
  • Licking or chewing affected area
  • Abnormal posture
  • Abnormal gait
  • Staring, squinting, grimacing,
  • Vocalization
  • Failure to groom/ use litterbox
  • Insomnia/ inappetence
  • Increased/ decreased urination
65
Q

When are opioids indicated?

A
  • Acute or chronic pain

- Sedation

66
Q

When are opioids contraindicated?

A
  • Gastroporesis/ ileus
  • vomiting
  • Pancreatitis
  • Hypothyroidism
  • Head injuries
  • Renal insufficiency
  • Respiratory dysfunction
67
Q

What is the difference in effect with parital mu agonist compared to full mu agonist?

A
  • Partial and mixed mu agonists have a ceiling effect for pain control. Full mu do not –> better for controlling severe pain

Plunkett Emergency (8 decks)

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