Test 2: lecture 36 shock part 2

Question 1

DO2= — x—

Answer 1

CO x CaO2

Question 2

flow by O2 will help

Answer 2

SaO2 and PaO2 → increased artial oxygen content → increase tissue oxygen delivery

Question 3

IV fluids will help

Answer 3

increase preload → increase SV → increase cardiac output → increase tissue oxygen delivery

Question 4

initial treatment plan for shock

Answer 4

flow by O2
IV catheter
IV fluids
pain meds

Question 5

what kind of fluids for shock

Answer 5

Isotonic crystalloid (NormR)
* The “work horse” of shock resuscitation

Dose
* Dog – 80-90 mL/kg
* Cat – 45-60 mL/kg (careful)

Administer 1/4 to 1/3 of the total dose as a bolus over 10-15 minutes and then reassess

Question 6

— will cause shift from intracellular to intravascular volume
rapid volume expansion x 3

Answer 6

hypertonic cystalloids

good for traumatic brain injury cause hyperosmolar effect can reduce cerebral edema

Can cause ↑Na

Question 7

— are good fluids for hypoproteinemic patients

Answer 7

synthetic colloid

Some synthetic colloids have been associated with the development
of a coagulopathy and acute kidney injury

Question 8

Some synthetic colloids have been associated with the development
of a —

Answer 8

coagulopathy and acute kidney injury

Question 9

when to give plasma

Answer 9

shock resuscitation in patients with clinically significant coagulopathy (not clotting)

Question 10

red cells or whole blood cells can be given —

Answer 10

over 1-4 hours or rapidly if life treatening

Question 11

if not returned to normal after initial bolus what can you give

Answer 11

Vasopressor if patient is vasodilated – norepinephrine, dopamine, vasopressin (only after adequate volume)

Positive inotrope if cardiac contractility is decreased – dobutamine

Red cell transfusion if moderate-severe anemia

Question 12

what are signs of fluid overload from fluid therapy

Answer 12

nasal discharge
chemosis (pink eyes)
cough
new murmur
crackles
edema, tachypnea, dyspnea

Question 13

dog in shock
kg= 30 how much plasmalyte to give?

Answer 13

plasmalyte is an isotonic cystalloid

80 ml/kg x 30 kg= 2400

give 1/4 over first 15 minutes= 600 mL

then reassess

Question 14

how to calculate fluid need

Answer 14

maintenance
deficit
ongoing losses

Question 15

how to calculate maintenance fluid

Answer 15

1-2 mL/kg/hr

[(BW x Kg) ^(0.75) ]x 70 (mL/day)

Question 16

how to calulate fluid deficit

Answer 16

BW kg x % dehydrated x 1000= mL to replace over 12-48 hrs

Question 17

7 yr FS Pittie 25 kg
PC Non-stop vomiting x 2 day
HR 170
Red MMs, CRT 1 second
Bounding pulses, cool extremities
8% Dehydrated
Moderate-severe abdominal pain

what is your initial stabilization plan?

Answer 17

shock fluid
80 mL/kg plasmalyte x 25 kg = 2000 mL
1/4 over 10-15 minutes = 500 mL bolus

pain med: methadone 0.2 mg/kg IV

antiemetic: cerenia mg/kg IV