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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

(Weight goes up on scale)

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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

AnapHylAxis = HALO

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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
Cardiac index
3.5-5.5L/min/m2
26
CVP
Central venous pressure 0-5cm H20 <0 hypovolemia >10 fluid overload, R sided ❤️ failure, pleural effusion
27
Cat shock organ
Respiratory, then GI Heart failure, asthma, infectious
28
Dog shock organ
GI tract
29
CRBSI
Catheter related bloodstream infection -fever, phlebitis, purulent discharge -culture Can leave in place if no local signs present
30
Na
Sodium Most abundant solute in the extracellular fluid
31
HCM
Hypertrophic cardiomyopathy Most common ❤️ disease in cats Walls of the muscle thicken, backward flow failure (ventricular myocardium)
32
DCM
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
33
BP
BP = CO x SVR
34
R sided ❤️ failure
Ascites
35
L sided heart failure
Pulmonary edema
36
O2ER
Oxygen extraction ratio O2ER = VO2/DO2 (0.3-0.6)
37
❤️ failure in cats
Hypothermia + decreased perfusion
38
CaO2
Arterial oxygen content CaO2 = (Hb x 1.36 x SaO2) + (PaO2 x 0.003)
39
Tranquilizers for respiratory distress
Butorphanol and acepromazine (best option) can cause vasodilation Diazepam or midazolam Dexmedetomidine - with normal ❤️ function Ketamine
40
Hypoxia
Inadequate DO2 to meet tissue metabolic demand 1. Hypoxemic hypoxia 2. Hypemic hypoxia 3. Stagnant hypoxia 4. Histiocytic hypoxia 5. Metabolic hypoxia
41
DO2
Rate of oxygen delivered to tissues CO x CaO2 = DO2
42
Well perfusion
CVP - 0-5 H20 Urine production 1ml/kg/hr Mean arterial pressure >60mmHg ScvO2 >70%
43
Baroreceptors
⬇️ parasympathetic, ⬆️ sympathetic ⬇️ firing leads to neuroendocrine response Vasoconstriction, ⬆️ HR, ⬆️ ❤️ contractility
44
ACTH
Adrenocorticotropic hormone Adrenal cortex to release cortisol
45
ADH
Antidiuretic hormone
46
RSI
Rapid sequence intubation -Propofol -Alfaxalone
47
Antibiotics for sepsis
Ampicillin + Enrofloxacin w/in one hour Hit HARD, FAST, STOP quickly
48
Butterfly/winged catheters
Short term use Increases risk for hematoma and extravasation of injected meds
49
Over the needle catheters
Most common <600mOsm osmolality >72 hours if no issues arise
50
Through the needle catheter
Long catheters = long lines PICC line - advance into caudal vena cava CVP monitoring >600 mOsm
51
Multi-lumen catheters
Central lines - single, double, triple Seldinger technique >600 mOsm TPN CVP No coagulopathy Heparinized saline!
52
IO catheters
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
Virchow’s triad for thrombosis
1. Endothelial damage - trauma to vein 2. Blood stasis/turbulent blood flow 3. Hypercoagulability (IMHA, neoplasia)
54
Thrombosis
Formation of a clot on catheter or vessel wall Lameness, cool extremities, loss of function
55
Phlebitis
Inflammation of vessel wall
56
Catheter embolism
Fragment of catheter breaks off and enters circulation
57
MAP
Mean arterial pressure Plays biggest role in perfusion “tree of life” MAP = CO x SVR >60mmHg
58
BP cuff size
40% circumference of leg
59
Arterial BP
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
Indirect BP
Doppler Osillometric
61
FiO2
Fraction of inspired oxygen Room air - 21% Flow by 5L/min - 30-60% Face mask - 50-60% Oxygen hood - 30-40%
62
Metabolic hypoxia
Increased cellular consumption of oxygen Not enough to go around -Sepsis
63
Nasal O2
Tip of nose to lateral canthus of eye 50-150ml/kg/min=FiO2 30-70%
64
Transtracheal O2
3rd-5th tracheal ring 50-150ml/kg/min - through the needle 50ml/kg/min - large bore multi lumen Requires sedation +/- anesthesia
65
Hyperbaric O2
100% FiO2 under supratmospheric pressure (>760mmHg) Risk of ruptured tympanum and pneumothorax
66
aFast
-Diaphragmatic-hepatic (xyphoid) -Cystocolic (bladder) -Splenorenal -Hepatorenal (both retro peritoneal spaces) AFS score (0/4)
67
HFOT
High flow oxygen therapy FiO2 near 100% Low levels of PEEP - positive end expiratory pressure
68
Blood products
Whole blood - 20ml/kg pRBC’s - 10ml/kg FFP - 10ml/kg Serum albumin HBOC - hemoglobin based oxygen carrying
69
Colloids
Hydroxyethyl starches, gelatins, dextrans Molecular weight >10000 daltons Vetstarch Hespan Voluven 2.5-5ml/kg Concerns over AKI, increased mortality
70
Hypertonic saline
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
Sedatives for respiratory distress
Butorphanol - less effect on ❤️ function Morphine, Hydromorphone, Oxymorphone, Methadone Buprenorphine - ineffective sedative
72
Circulating blood volume
90ml/kg dog 60ml/kg cat
73
Crystalloids
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
BIG 3
BG, PCV, TP
75
Vasopressin
Vasoconstrictor for refractory hypotension ADH 0.01-0.04 units/kg/min
76
Norepinephrine
Mixed adrenergic agonist Used in distributive shock Increases cardiac output and can result in profound bradycardia 0.1-2mck/kg/min
77
Dobutamine
Positive inotrope Beta-1 adrenergic agonist Increase cardiac contractility and cardiac output 1-20mcg/kg/min CRI needed Does not increase BP
78
Dopamine
Catecholamine CRI needed Increases cardiac output and BP 5-13mcg/kg/min
79
Vasopressors and inotropes
Aka “pressors” Adjust vascular tone and adjust cardiac contractility Dopamine Epinephrine Dobutamine Norepinephrine
80
Cardiogenic shock
Decreased in forward flow from ❤️ NO FLUID BOLUSES Inability of ❤️ to maintain normal cardiac output -CHF -cardiac arrhythmia -cardiac tamponade -drug overdose
81
Obstructive shock
Physical obstruction in circulatory system ❤️worm Saddle thrombus Pericardial effusion GDV
82
Hypoxemic shock
Decrease in oxygen content in arterial blood Anemia Severe pulmonary disease Carbon monoxide toxicity Methemoglobinemia
83
Compensatory
Initial signs (still compensating) Tachycardic Normal mm’s or prolonged Tachypnea Cool extremities Normal BP Pulse quality normal
84
Decompensated
Pale mm’s Poor peripheral pulse quality Depressed mentation Decreased BP Early and late
85
Metabolic shock
Deraned cellular metabolic machinery Hypoglycemia Cyanide toxicity Mitochondrial dysfunction Cyopathic hypoxia of sepsis
86
Distributive shock
Marked decrease or increase in systemic vascular resistance or maldistribution of blood Sepsis Obstruction Anaphylaxis Catecholamine excess SIRS
87
RAAS
Renin angiotensin aldosterone system Decreased renal flow and baroreceptor firing = systemic vasoconstriction and water and sodium retention Occurs from release of renin = renal
88
Aldosterone
Body’s main mineralcorticoid hormone Produced by adrenal gland Vasoconstrictive Conserves sodium in kidneys Excretes potassium out of kidneys Sodium - IN Potassium - OUT
89
Lactate
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
Hyperlactemia
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
Shock index
Evaluates severity of hypovolemic shock HR/Systolic BP Mod to severe >0.9-1 >1 acute small volume blood loss
92
PvO2
Mixed venous blood gases
93
IVC size
SHORTEST LENGTH, LARGEST GAUGE
94
Plasma
Fresh or FFP Used in profound blood loss Coagulopathy Severe hypoalbuminemia 10-20ml/kg
95
pRBC’s
Given to increase oxygen content with severe anemia Can use in conjunction with FFP 10-20ml/kg
96
PAC
Pulmonary artery catheter Swan-Ganz catheter CVP PAP PvO2 SvO2 CO PCWP
97
98
Stagnant hypoxia
Circulating hypoxia Low CO and low blood flow
99
Hypemic hypoxia
“Anemic hypoxia” Decrease in circulating hemoglobin = decreased CaO2 and DO2
100
Histiotoxic hypoxia
Adequate delivery, but tissues are unable to extract and utilize oxygen appropriately -Cyanide poisoning -Carbon monoxide toxicity
101
Hypoxemic hypoxia
Inadequate DO2 from inadequate CaO2 Secondary to decreased PaO2 and SaO2

VTS ECC (6 decks)

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