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Doctor of Veterinary Medicine (Work in progress) > Veterinary Medicine - Emergency Care > Flashcards

Veterinary Medicine - Emergency Care Flashcards

1
Q

Shock Syndrome - What are the the 3 elements of the perfusion triangle?

A

Heart, Blood Vessels , Intra-vascular fluids/Blood

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2
Q

Shock Syndrome - DDs for Distributive Shock

A

Sepsis / SIRS, Obstruction (e.g. Thrombosis / GDV / Tamponade), Anaphylaxis, Neurogenic

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3
Q

Shock Syndrome - DDs for Hypovolemic Shock

A

Blood Loss (e.g. Coagulopathies / Trauma), Fluid Loss (Dehydration / Burns / Vomiting / Diarrhea / Polyuria ), 3rd Space losses (Peritoneal / Pleural / Pericardial Effusions)

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4
Q

Shock Syndrome - DDs for Cardiogenic Shock

A

Structural Cardiac Disease (e.g. MR, DCM, HCM) Arrhythmias Tamponade

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5
Q

Shock Syndrome - What does it mean physiologically when an animals is in a state of Compensated Shock?

A

Through compensatory mechanisms (i.e. Catecholamines / RAAS / Baro/Chemoreceptors) the body is still able to maintain BP and perfusion

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6
Q

Shock Syndrome - Compensated Shock - Clinical signs

A

Slightly Depressed, Tachypnea, Tachycardia , Cool extremities, Normal / Prolonged CRT, Normal Mucus Membranes, Normal BP, Normal Pulse Quality

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7
Q

Shock Syndrome - Decompensated Shock - Clinical Signs

A

Depression, Tachypnea, Tachycardia, Hypothermia, Low BP, Pale Mucus Membranes, Prolonged CRT, Weak Peripheral Pulse

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8
Q

Shock Syndrome - Septic shock responds well to fluid therapy (T/F)

A

False

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9
Q

Septic Shock / SIRS - Hyperdynamic Phase - Clinical signs

A

Tachycardia, Tachypnea, Fever, Bounding Peripheral Pulse , Hyperemic Mucus Membranes

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10
Q

Septic Shock / SIRS - Hypodynamic Phase - Clinical signs

A

Tachycardia, Tachypnea, Hypothermia, Pale Mucus Membranes, Weak Pulse, Cold Extremities, Prolonged CRT

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11
Q

Shock Syndrome - What organ is damaged first in dogs and what would be the clinical signs?

A

GI Tract. Vomiting / Diarrhea / Ileus / Melena / Hematochezia

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12
Q

Shock Syndrome - What is the main difference in clinical signs between Dogs and Cats?

A

Cats undergoing Decompensated/Hypodynamic shock can present with both Bradycardia as well as Tachycardia

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13
Q

Shock Syndrome - What is the first organ to be damaged in Cats?

A

Lungs

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14
Q

Shock Syndrome - What are the basic blood test we need to preform in a Shock Patient?

A

PCV/TS, Creatinine, Albumin, Glucose, Lactate

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15
Q

Shock Syndrome - After the patient has stabilized - What are additional diagnostics you can perform for finding the cause and additional monitoring?

A

X-Rays, Ultrasound, Echocardiography, Blood Gas, EKG, Pulse Oximetry

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16
Q

Shock Syndrome - What is the recommended fluid therapy model?

A

LRS / Saline. 20 ml/kg Boluses and reassess (e.g. improvement in heart rate, respiratory rate, pulse quality, BP)

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17
Q

Shock Syndrome - Regular fluid therapy failed. What are our 2nd line options in terms of fluids?

A

Hyperosmotic Saline, Colloids (i.e. Hetastartch), Blood Products (i.e. Plasma)

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18
Q

Shock Syndrome - Regular fluid therapy failed. What drugs are used for fluid-refractory shock? What are the main types of shock that are refractory to fluid therapy?

A

Vasoconstrictors (e.g. Norepinephrine, Vasopressin, Dopamine), Dobutamine (Positive Inotrope), Distributive Shock (e.g. Septic Shock, SIRS). *Cardiogenic Shock - Fluids are Contraindicated!

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19
Q

Shock Syndrome - What is the approach for treating the GI in shock patients? What drugs are indicated?

A

Treat with GI protectants, PPI (e.g. Omeprazole), H2 Receptor antagonists (e.g. Famotidine), Sucralfate

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20
Q

Cardiogenic Shock - What can help you determine that you are dealing with a Cardiogenic Shock?

A

Signalment (e.g. MR - small breed, middle age-old dogs, DCM - Doberman Pinscher), History (e.g. Chronic cough), Clinical signs & PE findings (e.g. Murmur, Cyanosis, Crackles), Diagnostics: T-Fast (e.g. B-Lines, High LA:Aorta ratio), NT-ProBNP, Echocardiography

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21
Q

Cardiogenic Shock - Basic Treatment

A

Sedation (e.g. Butorphanol), Oxygen, Diuretics (e.g. Furosemide / Spironolactone), Positive inotropes (e.g. Pimobendan, Dobutamine), Anti-arrhythmogenic treatment (if indicated)

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22
Q

Shock Syndrome - Treatment End-Goals

A

Normal Temp, Normal Mucus Membrane + CRT, HR - 70-120, Normal RR

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23
Q

Relative Adrenal Insufficiency - What does this theory mean for in regards to shock syndrome treatment?

A

When an animal is refractory to vasopressors - Give basal blood concentration of Glucocorticoid - Catecholamines need a certain amount of cortisol in the blood in order to work

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24
Q

Hypercalcemia - Treatment

A

Fluid diuresis, Steroids, Furosemide, Bisphosphonate, Calcitonin

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25
Q

Xylitol Poisoning - Common panel findings

A

Hypoglycemia, Hypokalemia, Elevated liver enzymes

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26
Q

Xylitol Poisoning - Pathogenesis

A

Induces hyper-secretion of Insulin => Hypoglycemia & Hypokalemia

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27
Q

Emesis-induction in Poisoning - Name our options & Which are for dogs and which are for cats

A

Apomorphine - Dogs, Xylazine (Rompun) / Medetomidine -Cats, 3% Hydrogen Peroxide - Dogs

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28
Q

Common side effect of activated charcoal seen in Biochemistry panel

A

Hypernatremia (highly osmolar substance)

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29
Q

Poisoning decontamination methods - Name them all (By order)

A

Emesis - Apomorphine / Rompun / Hydrogen Peroxide, Gastric Lavage, Activated Charcoal, Cholestyramine , Surgery

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30
Q

Pyrethroids Poisoning - What is the only concentration that is allowed to be used on cats?

A

0.1% Pyrethroid

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31
Q

Pyrethroids Poisoning - What is the system affected? What are the clinical signs?

A

Nerves System. Hyperesthesia, Tremors (Face / Ears / Body), Seizures, Hyperthermia

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32
Q

Pyrethroids Poisoning - Treatment of choice (Plus additional one that helps in refractory cases)

A

Methocarbamol . *Diazepam - Helps reduce hyperesthesia and is synergistic with Methocarbamol

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33
Q

Acetaminophen Toxicosis - 2 Common effects on red blood cells (One can be seen on CBC & Blood smear)

A

Methemoglobinemia, Heinz Bodies Anemia

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34
Q

Acetaminophen Toxicosis - Main organ affected

A

Liver

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35
Q

Acetaminophen Toxicosis - Main pathologic effect seen in Cats? Dogs?

A

Cats - Methemoglobinemia Dogs - Liver failure

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36
Q

Acetaminophen Toxicosis - Common clinical signs in Cats

A

Facial / Paw Edema, Brown Mucus Membranes

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37
Q

Acetaminophen Toxicosis - Methylene Blue is recommended in Cat Treatment (T/F)

A

False! Hard to titrate to appropriate dose and can worsen methemoglobinemia if not done correctly

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38
Q

PCV / TS - Which drops first in acute hemorrhage?

A

TS. (Reserve RBCs can be supplied by the spleen)

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39
Q

Transfusion Reaction - Treatment Options

A

Stop the Transfusion, Diphenhydramine, Steroids

40
Q

AFAST/TFAST/Global FAST - Heart short axis view visualizes..?

A

Right Ventricle, Left Ventricle

41
Q

AFAST/TFAST/Global FAST - Heart long axis view visualizes..?

A

Right Ventricle, Right Atrium, Left Ventricle, Left Atrium

42
Q

AFAST/TFAST/Global FAST - Gallbladder/Vena Cava - Flat Vena Cava signifies?

A

Anaphylaxis

43
Q

AFAST/TFAST/Global FAST - Gallbladder/Vena Cava - Fat Vena Cava and demonstrable Hepatic veins can signify?

A

Right sided heart disease, Pulmonary hypertension, Pericardial Effusion / Cardiac tamponade, Caudal Vena cava obstruction

44
Q

AFAST/TFAST/Global FAST - Pulmonary edema is signified by

A

B-Lines

45
Q

AFAST/TFAST/Global FAST - Ribs are are signified by

A

Acoustic Shadows

46
Q

AFAST/TFAST/Global FAST - Dry lung signified by

A

A-Lines, Glide sign

47
Q

AFAST/TFAST/Global FAST - Pulmonary “Wedge sign” signifies?

A

Distal PTE

48
Q

AFAST/TFAST/Global FAST - Gallbladder Edema (“Halo Sign”) - DDs

A

Anaphylaxis, R-CHF, Pericardial Effusion / Tamponade

49
Q

AFAST/TFAST/Global FAST - Anaphylaxis findings (3)

A

Low volume of fluids in the heart, Flat Vena Cava, Gallbladder with “Halo Sign”

50
Q

AFAST/TFAST/Global FAST - Pericardial effusion findings (3)

A

DH View - Fluids in the pericardial sac, Fat Vena Cava, Gallbladder with “Halo Sign”

51
Q

AFAST/TFAST/Global FAST - R-CHF Signs (4)

A

Enlarged right ventricle (Short/Long axis view), Fat Vena Cava, Gallbladder with “Halo Sign”, +/- Peritoneal Effusion (Modified Transudate)

52
Q

AFAST/TFAST/Global FAST - What is the algorithm for ruling out and ruling in Pneumothorax

A

1) Is there a Glide sign? => Yes = Rule out. 2) Are there B-Lines? => Yes = Rule out. Both 1) and 2) Negative? => Pneumothorax can only be suspected. 3) Is there a “Lung Point”? => Yes = Pneumothorax Confirmed

53
Q

AFAST/TFAST/Global FAST - What is the “Curtain Sign” and what does it signify?

A

The transition between the lung region and the Diaphragm / Liver. You’ve gone caudally as much as you can

54
Q

AFAST/TFAST/Global FAST - Where do B-Lines originate from? What does it mean if a specific location has B-Lines in terms of ruling in/out Pneumothorax?

A

Visceral Pleura (Fluids within). Pneumothorax ruled out at that location

55
Q

AFAST/TFAST/Global FAST - What are the 2 best sites to evaluate presence of Pleural effusion? and in what position?

A

1) Sub-xiphoid site. 2) Caudal to the heart. Sternal position (Fluid is gravity dependent)

56
Q

AFAST/TFAST/Global FAST - At a single point - How many B-Lines are abnormal? What do they signify when abnormal?

A

> 2 or 3. Alveolar / Interstitial Syndrome (Fluid-filed lungs)

57
Q

AFAST/TFAST/Global FAST - You found >2-3 B-lines in several thoracic sites. Common DDs?

A

Cardiogenic / Non -Cardiogenic Edema, Lung contusion, Aspiration pneumonia

58
Q

Accelerated Idioventricular Rhythm - Management / Treatment

A

If not multi-focal: Check and correct Electrolytes | Oxygen | BP | Pain . If multi-focal: Administer Lidocaine

59
Q

Feline Blood Transfusion - What breed is100% A-Type blood always?

A

Siamese

60
Q

Feline Blood Transfusion - What breed has an unusual proportion of AB blood type

A

Ragdoll

61
Q

Feline Blood Transfusion - Neonatal Isoerythrolysis - Common Blood Types of Kittens and Queen?

A

Kittens - A or AB. Queen - B (Colostrum has anti-A Antibodies)

62
Q

Feline Blood Transfusion - Common presentation / clinical signs of kittens with Neonatal Isoerythrolysis

A

Sudden death, Pigmenturia, Icterus

63
Q

Feline Blood Transfusion - Acute reaction to blood transfusion - What are the common clinical signs?

A

Anaphylaxis, Urticaria, Vomiting, Tachypnea, Tachycardia / Bradycardia, Collapse

64
Q

Methocarbamol - Indication

A

To control uncontrolled muscle tremors as a result of a toxic agent (i.e. Methyl aldehyde / Pyrethroids )

65
Q

What are 2 common Vasopressors used in an emergency setting / anesthesia complications?

A

Dopamine, Norepinephrine

66
Q

What is the Vasopressor recommended for CPR? When should it be administered during CPR?

A

Epinephrine. Every other cycle of resuscitation (4-5 minutes)

67
Q

CPR - What are the shockable rhythms? What is the treatment algorithm?

A

Pulseless V-Tach / V-Fib. 1) Defibrillate 2) Give Lidocaine / Amiodarone 3) Epinephrine 4) Defibrillate again

68
Q

CPR - What are the non-shockable rhythms? What is the treatment algorithm?

A

Pulseless electrical activity / Asystole. 1) Low dose Epinephrine + Atropine 2) High Dose Epinephrine

69
Q

CPR - What are the 2 most important monitoring devices during CPR?

A

ECG, Capnograph

70
Q

First steps for every emergency patient - What do you check first? Elaborate on each step

A

Airway - Oropharyngeal Elexam. Breathing - Examine breathing pattern, Auscultate the lung field. Circulation - Auscultate heart | Palpate pulse | Check CRT | Evaluate mucus membranes

71
Q

Where do you perform Abdominocentesis (No US available)

A

Around the umbilicus

72
Q

Where do you perform Thoracentesis (No US available)

A

Intercostal spaces 6-10 in the cranial aspect of the rib: -Dorsally: when Pneumothorax is suspected. -Ventrally: when Pleural effusion is suspected

73
Q

What is “Hypotensive Resuscitation” and when do we use It? What is the end goal?

A

When we have a Hypotensive animal that is also losing blood and we want to elevate BP and increase perfusion to the tissues but don’t want to exacerbate bleeding via increasing intravascular hydrostatic pressure and prevent advantageous thrombus formation. End Goal - SAP = 70-90mmhg / MAP = 60mmhg

74
Q

What is the “Secondary survey” in a critical patient and when is it performed?

A

Full physical examination from nose to tail to look for lesions / injuries. Only after evaluating & stabilizing the patient (according to ABC)

75
Q

Chylothorax in Felines - Sequela

A

Fibrosing Pleuritis

76
Q

Chylothorax in Felines - Diagnosis

A

Thoracentesis findings: Milky white substance with high TS, High Triglycerides, Abundant in Lymphocytes

77
Q

Chylothorax in Felines - Treatment

A

Medical: Rutin (increases lymphatic vessel uptake of edema fluid, reduces inflammation and fibrosis that accompanies chylothorax). Surgical: Subphrenic Pericardiectomy, Thoracic Duct ligation, Cisterna Ablation. *Preferably a combination of 2 or more of the above procedure. Other surgical procedures: Pleural port Omentum placement in the thorax

78
Q

Chylothorax - How can you improve visualization of the thoracic duct for an upcoming surgery? (3 Options)

A

High-fat meal before procedure. Inject Methylene Blue into the Cisterna Chyli. Inject Methylene Blue into the Popliteal lymph node

79
Q

Sepsis - Common causes

A

Peritonitis, Pyometra, Pyothorax, Pancreatitis, Prostatitis, Pneumonia, Parvo enteritis , Wound infection

80
Q

Sepsis - Common CBC changes

A

Anemia, Neutrophilia / Neutropenia, Thrombocytopenia

81
Q

When does the Total Solids (“TS”) start to drop in acute hemorrhage? How long does it take to reach its lowest point?

A

Immediately . ~12h - 24h

82
Q

When does the PCV start to drop in acute hemorrhage? How long does it take to reach its lowest point?

A

12h-24h. 48-72h

83
Q

After treatment and resolution of acute hemorrhage - how long des it take for the TS levels to normalize?

A

5-7 Days

84
Q

After treatment and resolution of acute hemorrhage - how long des it take for the PCV levels to normalize?

A

2-4 Weeks

85
Q

Decreased lung sounds - 4 DDs

A

Dorsal - Pneumothorax. Ventral - Pleural Effusion. Neoplasia. Diaphragmatic Hernia

86
Q

What’s the Difference between Hyperthermia and Fever?

A

Fever - Change in hypothalamic temp set point. Hyperthermia - Elevation of core temp

87
Q

What 3 Elements Define Heat Stroke?

A

1) Hyperthermia 2) CNS Signs 3) Multiple Organ Dysfunction Syndrome (MODS)

88
Q

Heat stroke - common presentation and clinical signs

A

Stupor / Seizures / Coma, Hyperthermia, Tachycardia / Arrhythmia, Tachypnea / Panting, Weak Pulse, Hypotension / Hyperemic MM , Petechiae / Ecchymoses, Pigmenturia , Vomiting / Diarrhea +/- Melena / Hematochezia, Oliguria / Anuria, Ventricular Arrhythmias, Pulmonary Edema

89
Q

Heat Stroke - Treatment

A

Cooling - Room Temp Water + Fan. Fluids + Electrolyte +/- Vasopressors if Remains Hypotensive. Plasma. O2. GI Protectants + Anti-Emetics. AB (If GI Bleeding -> Translocation Possible). Phenobarbital +/- Mannitol / Hypertonic Saline (Seizures). Lidocaine (V-Tech). AKI - Treatment and Monitoring of Urine Output +/- Dialysis

90
Q

Heat Stroke - Common Lab Findings

A

Neutrophilia/Neutropenia, Lymphocytosis (nRBC), Erythrocytosis or Anemia (Bleeding), Thrombocytopenia (Consumption), Hypoproteinemia (GI Bleeding), High ALT / High AST / High CK, Hyperbilirubinemia , Electrolyte Changes, Azotemia , Hypoglycemia (Sepsis), Myoglobinuria, Proteinuria, Glucosuria, High PT/aPTT

91
Q

Common blood smear finding in intra vascular hemolysis

A

Ghost Cells

92
Q

Blood smear - you get an abnormal high WBC count composed mainly of lymphocytes. What is a possible DD that is not WBC related that can cause this Increase?

A

Nucleated RBCs

93
Q

What are the steps of analyzing EKG

A

1) Find a normal QRS complex *No Normal QRSs - Evaluate the QRSs available 2) Bradycardia / Normal / Tachycardia 3) Regular / Irregular (-> Regularly-Irregular / Irregularly-Irregular) 4) All Ps have QRSs? All QRSs have Ps?

94
Q

Ventricular bigeminy - usually associated with what 2 types of diseases?

A

Hyperthyroidism, Structural diseases of the heart (HCM / RCM / Rarely DCM)

95
Q

Serotonin Syndrome - Common Clinical Signs

A

Agitation + CNS Signs, Hyperreflexia, Hyperthermia, Tachycardia, Tachypnea, Hypertension, Muscle Fasciculations / Tremors, Mydriasis, Diarrhea

96
Q

Serotonin Syndrome - Treatment

A

Cooling, Assisted emesis, Activated charcoal, Cyproheptadine, Acepromazine (for hypertension / Anti-serotonergic), +/- Benzodiazepine, +/- Beta Blockers

Doctor of Veterinary Medicine (Work in progress) (17 decks)

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