Treatment of Shock Flashcards
Outline how the 4 types of shock are treated…
Hypovolaemic - IVFT
Obstructive - Relieve +/- IVFT
Vasodilatory - IVF +/- Vasopressors
Cardiogenic - Antirrhythmics and positive intropes
What type of shock should IVFT not be used for?
Cardiogenic
Where does IVFT end up if given slowly?
1/4 in IV
3/4 into interstitial
None moves intracellularly as needs a change in Na
What factors affect fluid movement in/out of capillaries?
Hydrostatic pressure
Oncotic pressure
Capillary permability
What mainly determines oncotic pressure?
Albumin levels in the blood
Which fluid compartment is filled when treating shock? How is this done?
IV
Fluid bolus/v fast infusion to prevent absorption into intersitium
What is the maximum volume of fluid you can give to dogs and cats?
No more than 1 blood volume
D - 80mL/kg
C - 50mL/kg
Which patients are most at risk of fluid overload?
Cardiac patients Pulmonary disease Oliguric/anuric renal failure Cats Hypoalbuminaemia Sepsis/SIRS
What are the signs of fluid overload?
Pulmonary oedema
Peripheral swelling
Jelly-like skin tent
Oedematous conjunctiva
What types of fluid are used to treat shock?
Crystalloids
Isotonic - Hartmann’s, CSL, LRS
Hypertonic - 7% NaCl
Colloids
Synthetic - Volulyte
What does Hartmann’s contain? How does it compare to 0.9% NaCl?
Na K Cl Ca Lactate 0.9% NaCl only contains Na and Cl but at higher levels than Hartmann's
What is the function of lactate in Hartmann’s?
Metabolise to bicarbonate -> Treats metabolic acidosis
what can’t be given at the same time as Hartmann’s due to it containing Ca and why?
Blood products - Ca chelates with blood preservatives
When are bolus and slow administrations of crystalloids indicated?
Bolus
Hypovolaemic shock
Obstructive shock
Vasodilatory shock
Slow
Dehydration/maintenance
Diuresis
What occurs commonly with shock and can it be treated with Hartmann’s?
Metabolic acidosis - yes because contains lactate
What are the fluid bolsus doses for dogs and cats?
D - 10-20mL/kg
C - 5-10mL/kg
Over 15 minutes <4x
Make sure no additives in fluid!
Outline the mechanism of hypertonic saline for treating shock…
High conc of Na in blood –> water is drawn into vessels from interstitium
When is hypertonic saline indicated and contraindicated?
Indicated
Traumatic brain injury
Cerebral oedema
Large dog breed
Contraindicated
Hyper/hypoNa
Dehydration
How is hypertonic saline administered in shock?
2-4ml/kg over 10m
ONCE
Followed by isotonic
When are colloids indicated and contraindicated?
Indicated
Sever hypoproteinaemia
Large dog
Contraindicated
Coagulopathy
Renal failure
Sepsis
Why aren’t colloids used often/
Possible adverse effects
Kidney injury
Coagulopathy
Increased risk of fluid overload
How are colloids administered?
D - 5-10ml/kg, C - 2.5-5ml/kg
Over 15m
<4x
How are IVFT delivered to different sized animals to provide the correct rate? What type of catheter should be used?
Med-large - Pressure bag
Small-med - Fluid pump
Cats - Syringe by hand or by driver
Short, wide bore catheter
What must be done when treating obstructive shock?
Relieve the obstruction
How is vasodilatory shock treated?
IVFT - isotonic crystalloids
Treat underlying causes
Vasopressors
Name four vasopressors used to treat vasodilatory shock…
Dopamine
Noradrenaline
Adrenaline
Vasopressin
How is cardiogenic shock treated?
Treat underlying cause - arrhythmias, +ve intropes
Treat CHF - O2 furosemide, thoracocentesis
Give 3 examples of ventricular arrhythmias. What can they occur with?
VPCs Acclerated idioventricular rhythm (<180bpm) Ventricular tachycardia - Cardiogenic shock - Hypovolaemic shock - GDV (obstructive shock) - SIRS/sepsis (vadodilatory)
How is ventricular tachycardia treated?
Lidocaine IV @ 2mg/kg slow
