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4th Semester: MOD > Test 1: Fluids Therapy, Shock, and Sepsis > Flashcards

Test 1: Fluids Therapy, Shock, and Sepsis Flashcards

1
Q

The foundation of

The Problem Oriented Approach to Medicine

involves the systematic collection of information assembled in a database that is the same for each patient. What is included in this database?

A

Signalment

Owner’s Complaint

History

Physical Exam

Working Problem List

Differential Diagnosis List

Diagnostic Testing Plan for each problem on DDx

Treatment Plan and Prognosis

Therapeutic Plan and monitoring of efficacy

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2
Q

What does SOAP stand for?

A

Subjective, Objective, Assessment, Plan

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3
Q

What is used to monitor the efficacy of a therapeutic plan in the problem oriented approach to medicine?

A

SOAP

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4
Q

What are the steps of a general physical exam?

A

Inspection

Palpation

Auscultation

Percussion

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5
Q

Your body weight is ____% water

A

60%

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6
Q

40% of your body weight is water stored in the

_______ space

A

intracellular space

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7
Q

_______ space contains 1/3 of body water

A

extracellular space

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8
Q

What are the 3 compartments of extracellular space?

A

Interstitial (ECF)

Intravascular (plasma)

Transcellular (CSF, Synovial fluid)

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9
Q

What are the 2 basic non-blood fluids used in

fluid therapy?

A

Crystalloids

Colloids

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10
Q

This fluid ends up in

interstitial spaces

A

Crystalloids

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11
Q

This fluid remains in

intravascular spaces

(in the plasma)

A

Colloids

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12
Q

Hypotonic Crystalloid fluids

draws fluid into cells

because it has a

_____ osmolality than intravascular fluid

A

lower

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13
Q

Hypertonic Crystalloid fluids

draw water out of cells and into the intravascular space because it has a

_____ osmolality than blood cells and plasma

A

higher

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14
Q

Ringer’s Solution is an example of

a crystalloid ______ fluid

A

isotonic

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15
Q

Normosol M is an example of a

crystalloid ______ fluid

A

hypertonic

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16
Q

What is the most commonly used synthetic colloid fluid used?

A

Hetastarch

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17
Q

If you want to correct dehydration, shock, or diarrhea, what type of fluid would you use?

A

Crystalloids

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18
Q

What disorders or diseases can cause a patient to

have a low serum albumin level?

(Less than 3 or about 4.5)

A

Vasculitis

PLN (protein losing nephropathy)

PLE (protein losing enteropathy)

Liver Failure

Sepsis

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19
Q

In a patient with a low albumin level, what

type of fluid would you choose to treat it?

A

Colloids

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20
Q

What could happen if you give a

large amount of crystalloid?

A

Peripheral edema

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21
Q

When would you give a patient

a crystalloid and a colloid together?

A

Combine maintenance fluids with colloids in patients with low albumin

To decrease the amount of crystalloid used

To restore a fluid deficit of the intravascular space more rapidly

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22
Q

What type of fluid is used to replace fluid loss?

A

Replacement fluid

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23
Q

What type of fluid is used to replace daily sodium loss?

A

Maintenance fluid

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24
Q

What type of fluid can you give rapidly?

A

Replacement fluid

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25
Q

If you use a replacement fluid as a maintenance fluid, what could happen?

A

Patient could become hypernatremic

and their brain could swell causing CNS signs

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26
Q

What disease is contraindicated in Colloid usage

A

Heart failure

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27
Q

Human albumin, a colloid, causes what serious potential side effect in dogs?

A

Anaphylaxis

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28
Q

What are the 2 indications for use of

hypertonic saline (a crystalloid)?

A

Hypovolemic shock

(in cases withOUT dehydration or hypernatremia)

Head trauma

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29
Q

What are potential side effects

of rapid administration of hypertonic saline?

A

Bronchoconstriction

Bradycardia

HYPOtension

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30
Q

How many mLs of hypertonic saline

can you administer over 20 minutes to a dog?

To a cat?

A

Dog: 4-7 mL/kg

Cat: 2-3.5 mL/kg

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31
Q

What is the Sliding Scale of Scott

used to determine?

A

The amount of potassium to be added to fluids

based on the patient’s

existing K level

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32
Q

Why would you add potassium to fluids?

A

Because patients that aren’t eating

become hypokalemic in a few days

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33
Q

Kmax is how rapidly you can give fluids with potassium added to it.

What is the Kmax dose?

A

0.5 mEq/kg/hr

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34
Q

What is the best method of fluid administration

in a patient experiencing

Dehydration or Shock?

A

IV administration

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35
Q

What is the best method of fluid administration

for a pediatric animal?

A

Intraosseous administration

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36
Q

What is the best method of fluid administration

in a patient in chronic renal failure?

A

SubQ administration

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37
Q

How do you calculate the maintenance dose

of fluids for a dog?

For a cat?

A

Dogs need 60 mL/kg/day

Cats need 40 mL/kg/day

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38
Q

If a patient has decreased fluid in

intracellular or interstitial spaces,

it is suffering from what?

A

Dehydration

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39
Q

If a patient has decreased fluid in

intravascular spaces

it is suffering from what?

A

Shock!

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40
Q

What is the most common fluid used in vet med?

A

Isotonic crystalloid

41
Q

Replacement fluids and Maintenance fluids

are both

_______ fluids

A

isotonic fluids

42
Q

The sodium concentration of this type of fluid is

close to the

normal plasma sodium concentration

which is [140 mmol/L]

A

Replacement fluids

43
Q

The sodium concentration for

this type of fluid is

close to normal TOTAL body sodium concentration

which is [70 mmol/L]

A

Maintenance fluids

44
Q

What is the most commonly used

Replacement Fluid?

A

LRS

45
Q

Uh oh! You are a vet and only have replacement fluids

on hand, but you have a patient that needs maintenance fluids STAT! What do you do?

A

Give it the replacement fluids BUT:

Add POTASSIUM

and

Monitor Serum Sodium level

46
Q

If you want to restore clotting factors, antithrombin III or albumin, what type of fluid would you use?

A

Colloid, Plasma specifically

47
Q

What is the most commonly used synthetic colloid in vet med?

A

Hetastarch

48
Q

What is the max daily dose of Hetastarch in a CRI

which is formulated as a 6% solution in saline?

A

10-20 mL/kg/day

49
Q

A bolus dose of Hetastarch,

which is 5 - 10 ml/kg over

5 - 10 minutes

is given in what case?

A

Hypovolemia

50
Q

Some cats get restless or salivate when given

this fluid

A

Hetastarch

51
Q

You should NEVER give hetastarch to a patient

with

A

heart failure

52
Q

Cardiac patients should be given THIS formulation

of fluids because the high sodium load in the other

fluids can unmask preclinical congestive heart

failure due to volume overload because water follows sodium

A

0.45% NaCl +

2.5% dextrose

53
Q

If a patient has a prolonged capillary refill time (CRT)

but its eyes do not appear to be sunken,

what would you estimate its dehydration status to be?

A

10%

With sunken eyes would be 13%

54
Q

What are the signs of

hypovolemic shock?

A

Tachycardia

Bradycardia-in cats

Prolonged CRT

Poor pulses

Decreased urine output

55
Q

How do you calculate the fluid deficit in a dog or cat?

A

%dehydrated x body weight in (kg)

56
Q

In a dehydration case, how much of the

calculated fluid deficit needs to be replaced

within the first 4 - 6 hours?

A

HALF the deficit

57
Q

One circulating blood volume

is equal to what?

A

The shock dose fluid volume

58
Q

How do you calculate the shock dose,

which is equal to one circulating blood volume,

for a dog? For a cat?

A

Dog Shock Dose= 90 mL/kg/hour

Cat Shock Dose= 45 mL/kg/hour

59
Q

After calculating the shock dose volume,

you want to give 1/4 of that as a BOLUS immediately.

How do you calculate the BOLUS of the shock dose?

A

Weight in lbs and add a 0

60
Q

If an animal has a fever, how does this

change your fluid calculations for

maintenance fluids?

A

You give an additional 15 - 20 mL/kg/day

in cases of fever

61
Q

What is the most common type of shock?

A

Hypovolemic circulatory shock

62
Q

What MAP is considered a STRONG pulse?

A

MAP > 80 mmHg is strong

63
Q

SIRS (Systemic Inflammatory Response Syndrome)

is associated with this type of shock

A

Vasodilatory/Distributive

circulatory shock

64
Q

What are the 5 classifications of circulatory shock?

A

Hypovolemic

Cardiogenic

Vasodilatory/Distributive

Obstructive

A combination of the above

65
Q

Which disease is associated with obstructive circulatory shock, and it obstruction of venous return?

A

GDV

gastric dilation volvulus

66
Q

Sepsis, anaphylaxis, and emboli are all associated with

this type of shock

A

Vasodilatory/ Distributive

circulatory shock

67
Q

What kind of shock is caused by

an anesthetic overdose?

A

Cardiogenic circulatory shock

68
Q

What is hypoperfusion?

A

Decreased blood flow through an organ

69
Q

Septic shock results in _____ perfusion, and severely

altered hemodynamics

A

decreased

70
Q

What are the two phases of septic shock?

A

Hyperdynamic (warm)

Hypodynamic (cold)

71
Q

Which phase of septic shock is rarely seen in cats?

A

Hyperdynamic (warm) phase

is rarely seen in cats

72
Q

Which stage is more severe in septic shock?

A

Hypodynamic (cold) stage

which occurs after the warm stage has progressed

73
Q

Hypodynamic (cold) stage of shock can

progress to this syndrome

A

MODS

Multiple Organ Dysfunction Syndrome

74
Q

Describe the pathophysiology of the

compensated stage of shock

A

decreased blood volume–> decreased vessel filling–>

activation of stretch baroreceptors–> increased sympathetic stimulation and vasoconstriction

75
Q

What are a dog’s shock organs, the organs

which experience decreased blood flow during the

compensated stage of shock?

A

GI tract and Liver

76
Q

What are a Horse’s

shock organs, the organs

which experience decreased blood flow during the

compensated stage of shock?

A

GI tract and LUNGS

77
Q

What are a Cat, Ruminant, or Pig’s

shock organs, the organs

which experience decreased blood flow during the

compensated stage of shock?

A

LUNGS only

78
Q

What physiological change marks the

progression from the compensated stage of shock

to the decompensated stage of shock?

A

If the blood volume problem is not fixed,

  • the local tissue beds that were vasoconstricted*
  • start to vasodilate*
79
Q

The decompensated stage of shock can lead to

maldistribution of blood to non-essential organs, as well as this syndrome

A

MODS

multiple organ dysfunction syndrome

80
Q

What is the difference in treatment of hemorrhagic hypovolemic shock and non-hemorrhagic hypovolemic shock?

A

For hemorrhagic shock, you need a blood transfusion because blood and fluid is being lost to the internal OR external environment.

For non-hemorrhagic, fluid is being lost to the external environment, and it can be replaced with IV fluids

81
Q

What is the purpose of heparin in treatment of septic shock?

A

To improve the efficacy of antithrombin III in

neutralizing activated coagulation factors

82
Q

Why would vasopressors be considered

in treatment of septic shock?

A

If the jugular vein is distended, if crackles are heard on auscultation, or if the CVP is greater than 10 cm H20,

you would consider vasopressors because the patient

is at risk for fluid overload

83
Q

What are 2 examples of vasopressors?

A

Dopamine

Dobutamine

84
Q

Vasopressors are given for _______ shock,

Vasodilators are given for ______ shock

A

Vasopressors- Septic shock

Vasodilators- Cardiogenic shock

85
Q

What is the level at which

CVP (central venous pressure)

indicates fluid overload?

A

CVP >12 - 15 cm H20

is indicative of fluid overload

86
Q

Describe the pathophysiology of SIRS

A

PAMPS expressed by the pathogen (LPS or Endotoxin in gram neg bacteria or Peptidoglycan in gram pos bacteria) stimulate PRRs on host immune cells (monocytes, macs, neutrophils)

and the result is

intracellular signaling cascade that releases proinflammatory cytokines

87
Q

What are the 3 proinflammatory cytokines?

A

TNF

IL1

IL6

88
Q

What are the 3 anti-inflammatory cytokines?

A

IL4

IL10

IL13

89
Q

Leukotrienes, prostaglandins, thromboxanes, nitric acid, platelet activating factors, and free radicals

are all inflammatory ___-regulators

A

inflammatory up-regulators

90
Q

What is it called when inflammation is NOT contained?

A

SIRS

91
Q

When SIRS is due to infection, it is called _______

A

SEPSIS

92
Q

What are 6 things that can cause SIRS

that are non-infectious causes?

A

HYPOtension

Trauma and hemorrhage

Hypoxia and ischemia

Pancreatitis

Burns

Neoplasia

93
Q

Second Hit Theory occurs in what syndrome?

A

SIRS

94
Q

If SIRS or Septic Shock progress, they can turn into

this syndrome

A

MODS

95
Q

Failure of the coagulation system resulting in widespread clotting

but at the same time, bleeding

is called

A

DIC

Disseminated Intravascular Coagulopathy

96
Q

What is the main trigger for DIC?

A

Release of tissue factor

97
Q

What would you see on a lab panel that would

indicate DIC?

A

Prolonged PT and PTT

Thrombocytopenia

Low fibrinogen

Positive D-Dimer

98
Q

What are the 3 mechanisms of diarrhea?

A

Secretory

Malabsorptive/Maldigestive

Osmotic

4th Semester: MOD (3 decks)

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