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VTS ECC > Week 2 - Shock > Flashcards

Week 2 - Shock Flashcards

1
Q

UAO

A

Upper airway obstruction
-Laryngeal paralysis
-Tracheal collapse
-Brachycephalic

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2
Q

ABT

A

Autologous blood transfusion - own blood

Blood filter needed

Decrease risk of infection and reactions

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3
Q

aPTT

A

Activated partial thromboplastin time

Factors: VIII, IX, XI, XII

Prolonged result = decrease of <70% factors

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4
Q

PT

A

Prothrombin time

Factors: I, II, III, V, X

Prolonged result = decrease of >70% factors

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5
Q

⬆️ BUN

A

-Renal failure
-UO
-GI tract hemorrhage

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6
Q

Active hemorrhage

A

PCV of cavity fluid is within 5% of peripheral blood

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7
Q

MGCS

A

Modified Glasgow Coma Scale
3-18 (3 being the lowest, 18 is the highest)

Scored 1-6 on 3 categories:
LOC
Brainstem reflexes
Motor activity

<8 - 50% chance of survival

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8
Q

IRI

A

Ischemia reperfusion injury

-GDV, ATE, CPA, TBI

Treat with lidocaine, N-AC

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9
Q

ATE

A

Arterial thromboembolism

Secondary to feline cardiomyopathy

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10
Q

Perfusion markers

A

-SvcO2 >70%

-Lactate <3.2 mmol/L

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11
Q

SvO2

A

Central venous oxygen saturation

Venous Hb oxygen saturation

CO, Hb concentration, CaO2

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12
Q

SIRS

A

Systemic inflammatory response syndrome

Secondary to widespread tissue ischemia and or reperfusion injury

“Warm shock”
“Cold shock”

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13
Q

Anaphylaxis

A

Acquired immune reaction, IgE production

Gallbladder halo!! And ⬆️ ALT

(Distributive shock)

Cutaneous, GI, Resp, and ❤️

Treatment:
Anti-histamines
Glucocorticoids
Epinephrine
Bronchodilators

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14
Q

Ischemia

A

Decrease in blood flow

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15
Q

Hypovolemia on ECG

A

R wave amplitude decreases

Lack of R-R interval variation = ⬆️ sympathetic tone

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16
Q

Jugular vein distention

A

Sign of cardiogenic and obstructive shock

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17
Q

Hypovolemic shock

A

Most common

Decrease in circulating blood volume

Decrease in ❤️ preload, decrease CO

-hemorrhage
-severe dehydration
-trauma (HBC)

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18
Q

MODS

A

Multiple organ dysfunction syndrome

Secondary to reperfusion injury

GI tract first
Lungs
Kidneys

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19
Q

PAF

A

Platelet activating factor

Potent bronchoconstrictor
⬆️ vascular permeability
Enhance platelet aggregation

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20
Q

CHESS (syncope)

A

C - CHF history
H - hematocrit <30%
E - ECG abnormal
S - shortness of breath
S - Systolic BP <90mmHg

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21
Q

TLOC w/ cerebral hypoperfusion

A

(Transient loss of consciousness)

*Syncope - acute drop in BP

Rapid onset, short, complete recovery

Severe ❤️ rhythm disturbances are most common cause
-cardiac
-reflex-mediated
-orthostatic hypotension

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22
Q

TLOC w/o cerebral hypoperfusion

A

Seizures - hypersalivation

Metabolic - Addison’s, hypoglycemia, drugs, anemia, hypoxemia

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23
Q

Uroabdomen

A

Peritoneal fluid CREA:peripheral serum CREA

Fluid >2:1 serum

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24
Q
A
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25
Q

Cardiac index

A

3.5-5.5L/min/m2

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26
Q

CVP

A

Central venous pressure

0-5cm H20

<0 hypovolemia
>10 fluid overload, R sided ❤️ failure, pleural effusion

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27
Q

Cat shock organ

A

Respiratory, then GI

Heart failure, asthma, infectious

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28
Q

Dog shock organ

A

GI tract

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29
Q

CRBSI

A

Catheter related bloodstream infection

-fever, phlebitis, purulent discharge
-culture

Can leave in place if no local signs present

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30
Q

Na

A

Sodium

Most abundant solute in the extracellular fluid

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31
Q

HCM

A

Hypertrophic cardiomyopathy

Most common ❤️ disease in cats

Walls of the muscle thicken, backward flow failure (ventricular myocardium)

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32
Q

DCM

A

Dilated cardiomyopathy

Most common cause of cardiogenic shock

ECG - A-fib or ventricular tachycardia
Rads - enlarged ❤️, CHF

Forward and backward flow failure

Doberman’s, Danes

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33
Q

BP

A

BP = CO x SVR

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34
Q

R sided ❤️ failure

A

Ascites

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35
Q

L sided heart failure

A

Pulmonary edema

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36
Q

O2ER

A

Oxygen extraction ratio

O2ER = VO2/DO2

(0.3-0.6)

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37
Q

❤️ failure in cats

A

Hypothermia + decreased perfusion

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38
Q

CaO2

A

Arterial oxygen content

CaO2 = (Hb x 1.36 x SaO2) + (PaO2 x 0.003)

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39
Q

Tranquilizers for respiratory distress

A

Butorphanol and acepromazine (best option) can cause vasodilation

Diazepam or midazolam

Dexmedetomidine - with normal ❤️ function

Ketamine

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40
Q

Hypoxia

A

Inadequate DO2 to meet tissue metabolic demand

  1. Hypoxemic hypoxia
  2. Hypemic hypoxia
  3. Stagnant hypoxia
  4. Histiocytic hypoxia
  5. Metabolic hypoxia
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41
Q

DO2

A

Rate of oxygen delivered to tissues

CO x CaO2 = DO2

42
Q

Well perfusion

A

CVP - 0-5 H20
Urine production 1ml/kg/hr
Mean arterial pressure >60mmHg
ScvO2 >70%

43
Q

Baroreceptors

A

⬇️ parasympathetic, ⬆️ sympathetic

⬇️ firing leads to neuroendocrine response

Vasoconstriction, ⬆️ HR, ⬆️ ❤️ contractility

44
Q

ACTH

A

Adrenocorticotropic hormone

Adrenal cortex to release cortisol

45
Q

ADH

A

Antidiuretic hormone

46
Q

RSI

A

Rapid sequence intubation
-Propofol
-Alfaxalone

47
Q

Antibiotics for sepsis

A

Ampicillin + Enrofloxacin w/in one hour

Hit HARD, FAST, STOP quickly

48
Q

Butterfly/winged catheters

A

Short term use

Increases risk for hematoma and extravasation of injected meds

49
Q

Over the needle catheters

A

Most common

<600mOsm osmolality
>72 hours if no issues arise

50
Q

Through the needle catheter

A

Long catheters = long lines

PICC line - advance into caudal vena cava

CVP monitoring
>600 mOsm

51
Q

Multi-lumen catheters

A

Central lines - single, double, triple

Seldinger technique

> 600 mOsm

TPN
CVP

No coagulopathy

Heparinized saline!

52
Q

IO catheters

A

Quick for CPA
-Proximal tibia
-Trochanteric fossa of femur
-Greater tubercle of humerus
-Wing of ilium
-Ischium

12-24 hr

Risk of bone fractures, osteomyelitis

53
Q

Virchow’s triad for thrombosis

A
  1. Endothelial damage - trauma to vein
  2. Blood stasis/turbulent blood flow
  3. Hypercoagulability (IMHA, neoplasia)
54
Q

Thrombosis

A

Formation of a clot on catheter or vessel wall

Lameness, cool extremities, loss of function

55
Q

Phlebitis

A

Inflammation of vessel wall

56
Q

Catheter embolism

A

Fragment of catheter breaks off and enters circulation

57
Q

MAP

A

Mean arterial pressure

Plays biggest role in perfusion “tree of life”

MAP = CO x SVR

> 60mmHg

58
Q

BP cuff size

A

40% circumference of leg

59
Q

Arterial BP

A

Gold standard - direct BP

Systolic: 110-190 dogs, 120-170 cats
Diastolic: 55-110 dogs, 70-120 cats
Mean: 80-130 dogs, 60-130 cats

60
Q

Indirect BP

A

Doppler

Osillometric

61
Q

FiO2

A

Fraction of inspired oxygen

Room air - 21%
Flow by 5L/min - 30-60%
Face mask - 50-60%
Oxygen hood - 30-40%

62
Q

Metabolic hypoxia

A

Increased cellular consumption of oxygen

Not enough to go around

-Sepsis

63
Q

Nasal O2

A

Tip of nose to lateral canthus of eye

50-150ml/kg/min=FiO2 30-70%

64
Q

Transtracheal O2

A

3rd-5th tracheal ring

50-150ml/kg/min - through the needle

50ml/kg/min - large bore multi lumen
Requires sedation +/- anesthesia

65
Q

Hyperbaric O2

A

100% FiO2 under supratmospheric pressure (>760mmHg)

Risk of ruptured tympanum and pneumothorax

66
Q

aFast

A

-Diaphragmatic-hepatic (xyphoid)
-Cystocolic (bladder)
-Splenorenal
-Hepatorenal (both retro peritoneal spaces)

AFS score (0/4)

67
Q

HFOT

A

High flow oxygen therapy

FiO2 near 100%

Low levels of PEEP - positive end expiratory pressure

68
Q

Blood products

A

Whole blood - 20ml/kg
pRBC’s - 10ml/kg
FFP - 10ml/kg
Serum albumin
HBOC - hemoglobin based oxygen carrying

69
Q

Colloids

A

Hydroxyethyl starches, gelatins, dextrans

Molecular weight >10000 daltons

Vetstarch
Hespan
Voluven

2.5-5ml/kg

Concerns over AKI, increased mortality

70
Q

Hypertonic saline

A

7% NaCL

Rapid expansion of intravascular volume causing increased venous return and cardiac output, vasodilation, and increased tissue perfusion

*used for TBI to decrease cerebral edema

71
Q

Sedatives for respiratory distress

A

Butorphanol - less effect on ❤️ function

Morphine, Hydromorphone, Oxymorphone, Methadone

Buprenorphine - ineffective sedative

72
Q

Circulating blood volume

A

90ml/kg dog
60ml/kg cat

73
Q

Crystalloids

A

Various concentrations of lytes (Na, K, Cl, Mg), dextrose, free water

0.9% NaCL
LRS
Normosol-R
Plasmalyte-A
Hypertonic saline

15-20ml/kg

74
Q

BIG 3

A

BG, PCV, TP

75
Q

Vasopressin

A

Vasoconstrictor for refractory hypotension

ADH

0.01-0.04 units/kg/min

76
Q

Norepinephrine

A

Mixed adrenergic agonist

Used in distributive shock

Increases cardiac output and can result in profound bradycardia

0.1-2mck/kg/min

77
Q

Dobutamine

A

Positive inotrope

Beta-1 adrenergic agonist

Increase cardiac contractility and cardiac output

1-20mcg/kg/min

CRI needed

Does not increase BP

78
Q

Dopamine

A

Catecholamine

CRI needed

Increases cardiac output and BP

5-13mcg/kg/min

79
Q

Vasopressors and inotropes

A

Aka “pressors”

Adjust vascular tone and adjust cardiac contractility

Dopamine
Epinephrine
Dobutamine
Norepinephrine

80
Q

Cardiogenic shock

A

Decreased in forward flow from ❤️

NO FLUID BOLUSES

Inability of ❤️ to maintain normal cardiac output

-CHF
-cardiac arrhythmia
-cardiac tamponade
-drug overdose

81
Q

Obstructive shock

A

Physical obstruction in circulatory system

❤️worm
Saddle thrombus
Pericardial effusion
GDV

82
Q

Hypoxemic shock

A

Decrease in oxygen content in arterial blood

Anemia
Severe pulmonary disease
Carbon monoxide toxicity
Methemoglobinemia

83
Q

Compensatory

A

Initial signs (still compensating)

Tachycardic
Normal mm’s or prolonged
Tachypnea
Cool extremities
Normal BP
Pulse quality normal

84
Q

Decompensated

A

Pale mm’s
Poor peripheral pulse quality
Depressed mentation
Decreased BP

Early and late

85
Q

Metabolic shock

A

Deraned cellular metabolic machinery

Hypoglycemia
Cyanide toxicity
Mitochondrial dysfunction
Cyopathic hypoxia of sepsis

86
Q

Distributive shock

A

Marked decrease or increase in systemic vascular resistance or maldistribution of blood

Sepsis
Obstruction
Anaphylaxis
Catecholamine excess
SIRS

87
Q

RAAS

A

Renin angiotensin aldosterone system

Decreased renal flow and baroreceptor firing = systemic vasoconstriction and water and sodium retention

Occurs from release of renin = renal

88
Q

Aldosterone

A

Body’s main mineralcorticoid hormone

Produced by adrenal gland

Vasoconstrictive
Conserves sodium in kidneys
Excretes potassium out of kidneys

Sodium - IN
Potassium - OUT

89
Q

Lactate

A

Assess oxygen delivery

Normal <2.5mmol/L, up to 5 can be normal in cats (neonate and pediatric have higher level)

> 7 increases mortality

Produced by skeletal muscle, brain, adipose tissue, and circulating blood cells

90
Q

Hyperlactemia

A

Type A
Hypoperfusion
Anemia
Severe hypoxemia
Carbon monoxide toxicity
Seizure/tremor
Exercise

Type B
Systemic disease (DM, sepsis, SIRS, neoplasia)
Drugs or toxins
Inborn congenital disease
Disease of lactate metabolism

91
Q

Shock index

A

Evaluates severity of hypovolemic shock

HR/Systolic BP

Mod to severe >0.9-1

> 1 acute small volume blood loss

92
Q

PvO2

A

Mixed venous blood gases

93
Q

IVC size

A

SHORTEST LENGTH, LARGEST GAUGE

94
Q

Plasma

A

Fresh or FFP

Used in profound blood loss
Coagulopathy
Severe hypoalbuminemia

10-20ml/kg

95
Q

pRBC’s

A

Given to increase oxygen content with severe anemia

Can use in conjunction with FFP

10-20ml/kg

96
Q

PAC

A

Pulmonary artery catheter

Swan-Ganz catheter

CVP
PAP
PvO2
SvO2
CO
PCWP

98
Q

Stagnant hypoxia

A

Circulating hypoxia

Low CO and low blood flow

99
Q

Hypemic hypoxia

A

“Anemic hypoxia”

Decrease in circulating hemoglobin = decreased CaO2 and DO2

100
Q

Histiotoxic hypoxia

A

Adequate delivery, but tissues are unable to extract and utilize oxygen appropriately

-Cyanide poisoning
-Carbon monoxide toxicity

101
Q

Hypoxemic hypoxia

A

Inadequate DO2 from inadequate CaO2

Secondary to decreased PaO2 and SaO2

VTS ECC (3 decks)

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