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Small Animal ECC > 5 shock and SIRS > Flashcards

5 shock and SIRS Flashcards

1
Q

what is shock?

A

inadequate cellular energy production caused either by poor oxygen delivery or increased cellular oxygen consumption

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2
Q

what fraction of body water is intracellular? how easily accessible is this fluid?

A

2/3

NOT easily accessible

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3
Q

give rehydration fluids fast or slow? why?

A

slow

to give fluids time to get into cells

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4
Q

give fluids to fix plasma volume fast or slow?

A

fast - to rapidly expand fluid volulme

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5
Q

what fraction of body water is extracellular?

how is this extracellular fluid divided up?

A

1/3 is ECV

1/4 of this is plasma volume
and 3/4 of this is interstitial volume

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6
Q

dehydration is a lack of intra or extra cellular fluid volume?

which is hypovolemia?

A

deh = lack in intra cellular fluid volume

hypovolemia = lack of extra cell fluid volume

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7
Q

dec 02 delivery (DO2) is what?

A

diminished tissue perfusion

GDV, CHF, massive hemorrhage, anaphylaxis

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8
Q

inc o2 consumption is what?

A

inc cell metabolism

heat stroke, sepsis, seizures, tremors, etc

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9
Q

why does energy prod dec?

A

No o2 = shift to anaerobic metabolism

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10
Q

which is more efficient: aerobic metabolism or anaerobic metabolism?

A

aerobic metabolism MUCH MORE efficient

{36 ATP vs 2 ATP per cycle}

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11
Q

determinants of DO2?

A
  • CO

- CaO2

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12
Q

what is CO?

A

SV x HR

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13
Q

what is CaO2?

A

Hgb, SaO2, PaO2

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14
Q

classifications of shock?

A

cardiogenic
hypovolemic
obstructive
distributive / vasogenic

Call Help Or Die

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15
Q

PaO2 is a measure of?

A

amount o2 dissolved in blood

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16
Q

SaO2 is a measure of?

A

saturation of Hb

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17
Q

dehydration assessed based on what standard?

A

% loss of body weight

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18
Q

ciln signs of dehydration?

A

drastic change in body weight
skin turgor
mucus membrane turgor

cells lack fluid - extravascular loss

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19
Q

cardiogenic shock etiology?

how common is it?

A

2* to any severe cardiac dz

not common - MC heart problem in dogs is mitral valve insufficiency, which does not lead to shock

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20
Q

Tx cardiogenic shock?

A

pos ionotrope or chornotrope

NO fluids

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21
Q

hypovolemic shock can be further classified into 2 categories. what are they? and what are examples w/in each category?

A
  • absolute hypovolemia -
    hemorrhage - internal / external blood loss of whole blood from intravasclar space
  • relative hypovolemia - loss of plasma volume -
    severe deh, burns, cavitary effusions, anaphylaxis, snake bite
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22
Q

obstructive shock is?

ex?

A

obstruction of blood flow, px normal global tissue perfusion

GDV, caval syndrome, pericardial effusion, pulm thromboembolism

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23
Q

initial and long term Tx of obstructive shock?

A

initial - fluids

long term - Sx to correct underlying issue

24
Q

distributive shock is?

ex?

A

maldistribution of blood flow

severe systemic vasodilation -> pooling of blood in peripheral capillary beds b/c sys vasc cannot constrict and respond appropriately

SIRS, sepsis, endotoxemia, anaphylaxis, trauma

25
Q

clinical stages of shock are:

A

compensatory
early decompensatory
decompensatory

26
Q

signs of compensatory shock?

A

neurohumoral response

hyperdynamic

27
Q

early decompensatory signs of shock?

A

flow redistributes to heart and brain
Vo2 dependent on Do2
anaerobic shoft

28
Q

decompensatory or terminal stage of shock:

A

autoregulation fails

sympathetic control lost

29
Q

how do cats differ?

A 
cats often skip the decompensatory stage:
bradycardia
hypothermia
hypoglycemia
hypotension

smaller blood volume than dog

30
Q

overall approach to shock?

A

must ID and Tx underlying cause, support patient to treat or px SIRS / other complicatons

31
Q

overall general signs of shock?

A
  • pallor
  • tachycardia
  • dull mentation
  • cool extremities
  • poor pulse quality
32
Q

use of pressors?

A

inc SVR

33
Q

use of chronotropes?

A

inc HR

34
Q

use of fluids?

A

inc preload

correct hypovolemia
correct hemoconcentration
reverse/maintain hydration

35
Q

use of vasodilators?

A

reduce afterload

36
Q

use of contractility?

A

inc strength of contraction

37
Q

RBC transfusion?

A

inc Hb (o2 carrying capacity)

38
Q

o2 therapy?

A

inc dissolved o2

39
Q

monitor parameters for shock: in order of clinical applicability?

A 
mentation
MM color
CRT
HR
pulse quality
blood pressure
urine output
CVP
acid-base
40
Q

upper limit for shock dose of crystalloid?

purpose?

A

dogs: 80-90 mL/kg
cats: 50-60 mL/kg

give in 20 mL/kg aliquots

70% of amt given will move into interstitum w/in 1 hour of giving - makes blood hyperosmolar so fluid shifts from blood and into interstitum/tissue, where it is needed

41
Q

upper limit for colloid?

purpose?

A

up to 20 mL/kg

5 mL/kg aliquots (less in cats)

maintain fluid volume - volume expansion b/c inc oncotic pressure in vasculature
minimal change to osmolarity

42
Q

hypertonic saline upper limit dose?

A

4 mL/kg bolus

uncommon to use

43
Q

when to give crystalloid?

A

dehydrated
has kidney fxn
intact brain, lungs

44
Q

when to give colloid?

A

normal hydration
less volume desired
hypoproteinemic

45
Q

major drugs for ionotropic and pressor support?

what is route of administration?

A

dobutabmine: ionotrope

dopamine: low dose is ionotrope
high dose is pressor

IV CRI administration

46
Q

what is SIRS?

A

local problem causes systemic inflammation - an over correction to inflammation

2* to endogenous inflammatory mediators or bacT toxins

can cause shock or result from shock

47
Q

major cytokines in SIRS?

A 
IL 1
IL 6
IL 8
TNF a
platelet activating factor
48
Q

what end points should you give fluids to?

A
  • blood pressure
  • urine output
  • CVP
  • acid base parameters (base deficit, lactate)
49
Q

how is MODS caused?

A

animals w SIRS have damage to vascular endothelium from activation of coagulation, complement pathways, PGs and LTs

50
Q

which are the target cells for SIRS?

A

WBC
platelet
endothelial cells

51
Q

define MODS?

A

severe, acquired dysfunction of 2 or more organ systems for over 24-48 hours NOT due to 1* illness

52
Q

what are SIRS criteria?

A
  • hyper or hypothermia
  • tachycardia
  • tachypnea
  • respiratory alkalosis (low PaCo2)
  • leukocytosis or leukopenia (left shift)
53
Q

SIRS tx?

A
  • abx
  • GI protectants and nutrition [avoid break down]
  • positive pressure ventilation (ARDS)
  • anticipate and avoid complications
  • critically ill - req 24 hour care facility and monitoring
54
Q

when giving crystalloid and colloid solution at the same time, what adjustment needs to be made?

A

dec crystalloid dose by half the normal dose

55
Q

some etiology of infectious SIRS?

A 
pyometra
prostatitis
pyelonephritis
peritonitis
pneumonia
pancreatitis
56
Q

some non infectious etiology of SIRS?

A 
neoplasia
heat stroke
severe burns
severe trauma
snake envenomation
57
Q

steps to SIRS:

A

1 - local inflammation
2 - inflammatory mediators travel
3 - distant vascular endothelial effects
4 - MODS

Small Animal ECC (5 decks)

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