Supportive Therapy Flashcards
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
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
3
Q
What occurs at very high levels of respiratory acidosis? What numbers indicate this?
A
- PaCO2 60- 70 mmHg
- Narcosis, disorienation, coma noted
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)
5
Q
How do you treat respiratory acidosis?
A
Treat underlying cause, ventilation, oxygenation
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)
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)
8
Q
What changes to the pH, PaC02, and HC03 are noted with respiratory acidosis?
A
pH: decrease
PaC02: increase
HC03: increase or normal
9
Q
What changes to the pH, PaC02, and HC03 are noted with respiratory alkalosis?
A
pH: increase
PaC02: decrease
HC03: decrease or normal
10
Q
What changes to the pH, PaC02, and HC03 are noted with metabolic acidosis?
A
pH: decreaee
PaC02: decrease
HC03: decrease
11
Q
What changes to the pH, PaC02, and HC03 are noted with metabolic alkalosis?
A
pH: increase
PaC02: increase
HC03: increase
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
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
14
Q
When is a metabolic/ non-respiratory acidosis considered severe?
A
pH < 7.1
HC03 < 8 meq/L
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
16
Q
When is a metabolic/ non-respiratory alkalosis considered severe?
A
pH < 7.6
17
Q
What are causes of metabolic alkalosis?
A
- Hypochloremia (vomiting, diuretics)
- Chloride-resistance (Hyperaldosternonism, Cushing’s)
- Hypoalbumenia
18
Q
What are the 5 causes of hypoxemia?
A
- Hypoventilation (CNS disease, neuromuscular dz, medications, chest wall injury, upper airway disease)
- Decreased Fi02 (partial pressure of inspired oxygen): high-altitude, poor anesthetic equipment
- Ventilation-perfusion (V/Q) mismatch: asthma, bronchitis, COPD, pulmonary embolism
- Diffusion impairment: pulmonary interstitial disease, vasculitis, emphysema, pneumonia, pulmonary edema
- Right to left shunt:
19
Q
What is hypoxemia?
A
Inadequate oxygen in red blood cells
20
Q
What PCV is needed to adequately carry oxygen to cells?
A
30%, although 22-25 % is usually fine in healthy patients
21
Q
When is a patient considered hypoxemic? When does a patient become cyanotic?
A
- < 80 mmHG
- Visible cyanosis occurs at < 40 mmHg
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
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
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
25
When is a tracheostomy tube indicated?
- Severe upper respiratory obstruction
- Severe upper respiratory trauma
- Severe laryngeal paralysis
- Long-term positive pressure ventilation
26
When is hyperbaric oxygen indicated?
- Severe burns
- Osteomyelitis
- Severe soft tissue infections
27
What are signs of shock?
```
Tachycardia
Pale mucous membranes
Weak/ bounding peripheral pulses
Prolonged capillary refill time
Altered mentation
```
28
Where should you pinch the skin to check for dehydration?
Lumbar spine
29
What is the normal PCV range of a dog?
38%-55%
| Normal TS 6.0-8.0%
30
What is the normal PCV range of a cat?
29%-45%
| Normal TS 6.0-8.0%
31
What fluids are useful for correcting dehydration? How do they work?
Crystalloids: e.g LRS, NaCl, D5W, Normosol
| - These fluids replace intracellular (about 75% is absorbed in 30 minutes)
32
What fluids are useful for shock?
```
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
What dose should be used for 7.2% NaCl for dogs? Cats?
3-5 mL/ kg for dogs over 10 minutes
| 2-4 mL/kg for cats over 10 minutes
34
What occurs if hypertonic saline is given too rapidly?
Vagal-mediated hypotension and bradycardia
35
What conditions are hypertonic saline indicated for?
Shock
Head trauma
Spinal trauma
Circulatory shock
36
When is hypertonic saline contraindicated?
```
Dehydration
Volume overload
Hypernatremia
Hyperosmolality
Ventricular arrhythmias
Uncontrolled hemorrhage
```
37
How do colloids control blood pressure
- 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
What are examples of colloids?
Natural: whole blood, fresh frozen plasma
Synthetic: Hetastarch, Pentastarch, Dextran 70, Oxyglobin
39
What is the prognostic indicator of severe hypoalbuminemia in humans?
Poor
40
What is a shock dose of hetastarch?
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
What side-effect has been reported with hetastarch administration?
- Prolonged PTT although this does not trigger any adverse bleeding episodes
42
What is a side-effect of dextran 40?
Acute renal failure. Do not use this
43
What side-effect has been reported with dextran 70 administration?
Covers platelets and interferes with Von Willebrands and factor VIII
44
What is fresh frozen plasma?
Plasma frozen < 8 hours after being drawn and has been frozen < 1 year
45
What is frozen plasma? What are its components?
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
What is a good rule of thumb for volume to give for blood transfusions?
1 mL/ lb will increase the PCV by 1%
47
What should be done if a blood transfusion reaction is noted?
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
What sites can be used for intraosseous fluid administrations?
- Proximomedial tibia
- Tibial tuberosity
- Trochanteric fossa of femur
- Wing of ilium
- Ischium
- Greater tubercle of humerus
- Needs local antiseptic and anesthesia
49
What is normal systolic pressure in the dog? Diastolic? Mean?
Systolic: 90-140 mmHg
Diastolic: 50-80 mmHg
Mean: 60-100 mmHg
50
What is normal systolic pressure in the cat? Diastolic? Mean?
Systolic: 80-140 mmHg
Diastolic: 50-80 mmHg
Mean: 60-100 mmHg
51
What blood pressure value is considered hypotensive? What are causes of this?
- Mean arterial pressure <60 mmHg
- Hypovolemia
- Myocardial fibrosis
- Gastric distension
- Tachyacrdia
- Outflow tract obstruction
- Cardiomyopathy
- Ventricular arrhythmias
- Pericardial tamponade
- PDA
52
What are adverse reactions to hypotension?
- Acute renal failure
- Arrhythmias
- Mentation changes
- Coagulopathies
- Melena
- Tachypnea
- Vomiting
53
What are treatments options for hypotension?
- 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
What is hypertension considered? What are differentials?
- Systolic > 160 mmHg, diastolic > 95 mmHg
- Renal disease
- Hyperadrenocorticism
- Pheochromocytoma
- Hepatic disease
- Chronic anemia
- Hyperthyroidism
- Hyperaldosteronism
- Diabetes mellitus
- Polycythemia
55
What are ocular side-effects of hypertension?
- Glaucoma
- Retinal detachment
- Hyphema
- Perivascular edema
- Acute blindness
56
What is considered a hypertensive emergency? How can you treat this?
```
- 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
What are causes of elevated abdominal pressure?
- Hemoperitoneum
- Peritonitis
- Pancreatitis
- Ruptured urinary bladder
- Ileus
- Abdominal mass
- Urinary obstruction
- Blunt abdominal trauma
- Pelvic fracture
58
What are clinical signs of increased abdominal pressure?
- Short, shallow breaths
- Tense abdomen
- Decreased urine output
- Vomiting
- Obtunded
59
What are the benefits of enteral feeding?
- Maintains GI mucosal integrity
- Prevents intestinal villous atrophy
- Decrease risk of bacterial translocation
- Maintains GI immune function
60
What are daily water requirements?
50-100 mL/ kg/ day
61
When is an esophagostomy tube indicated?
- Inappetence
- Facial trauma
- Severe dental disease
- Stomatitis secondary to infection, potpourri oil, alkali ingestion
- Orofacial/ pharyngeal mass
- Orofacial surgery
62
What percentage of protein intake should cats and dogs with kidney or heptatic disease be fed?
50%
63
What are physiologic signs of pain?
- Salivation
- Increased respiratory rate
- Dilated pupils
- Increased heart rate +/- arrhythmias
- Increased temperature
64
What are behavioral signs of pain?
- 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
When are opioids indicated?
- Acute or chronic pain
| - Sedation
66
When are opioids contraindicated?
- Gastroporesis/ ileus
- vomiting
- Pancreatitis
- Hypothyroidism
- Head injuries
- Renal insufficiency
- Respiratory dysfunction
67
What is the difference in effect with parital mu agonist compared to full mu agonist?
- Partial and mixed mu agonists have a ceiling effect for pain control. Full mu do not --> better for controlling severe pain
