5 shock and SIRS

Question 1

what is shock?

Answer 1

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

Question 2

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

Answer 2

2/3

NOT easily accessible

Question 3

give rehydration fluids fast or slow? why?

Answer 3

slow

to give fluids time to get into cells

Question 4

give fluids to fix plasma volume fast or slow?

Answer 4

fast - to rapidly expand fluid volulme

Question 5

what fraction of body water is extracellular?

how is this extracellular fluid divided up?

Answer 5

1/3 is ECV

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

Question 6

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

which is hypovolemia?

Answer 6

deh = lack in intra cellular fluid volume

hypovolemia = lack of extra cell fluid volume

Question 7

dec 02 delivery (DO2) is what?

Answer 7

diminished tissue perfusion

GDV, CHF, massive hemorrhage, anaphylaxis

Question 8

inc o2 consumption is what?

Answer 8

inc cell metabolism

heat stroke, sepsis, seizures, tremors, etc

Question 9

why does energy prod dec?

Answer 9

No o2 = shift to anaerobic metabolism

Question 10

which is more efficient: aerobic metabolism or anaerobic metabolism?

Answer 10

aerobic metabolism MUCH MORE efficient

{36 ATP vs 2 ATP per cycle}

Question 11

determinants of DO2?

Answer 11

• CO

- CaO2

Question 12

what is CO?

Answer 12

SV x HR

Question 13

what is CaO2?

Answer 13

Hgb, SaO2, PaO2

Question 14

classifications of shock?

Answer 14

cardiogenic
hypovolemic
obstructive
distributive / vasogenic

Call Help Or Die

Question 15

PaO2 is a measure of?

Answer 15

amount o2 dissolved in blood

Question 16

SaO2 is a measure of?

Answer 16

saturation of Hb

Question 17

dehydration assessed based on what standard?

Answer 17

% loss of body weight

Question 18

ciln signs of dehydration?

Answer 18

drastic change in body weight
skin turgor
mucus membrane turgor

cells lack fluid - extravascular loss

Question 19

cardiogenic shock etiology?

how common is it?

Answer 19

2* to any severe cardiac dz

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

Question 20

Tx cardiogenic shock?

Answer 20

pos ionotrope or chornotrope

NO fluids

Question 21

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

Answer 21

• 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

Question 22

obstructive shock is?

ex?

Answer 22

obstruction of blood flow, px normal global tissue perfusion

GDV, caval syndrome, pericardial effusion, pulm thromboembolism

Question 23

initial and long term Tx of obstructive shock?

Answer 23

initial - fluids

long term - Sx to correct underlying issue

Question 24

distributive shock is?

ex?

Answer 24

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

Question 25

clinical stages of shock are:

Answer 25

compensatory early decompensatory decompensatory

Question 26

signs of compensatory shock?

Answer 26

neurohumoral response | hyperdynamic

Question 27

early decompensatory signs of shock?

Answer 27

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

Question 28

decompensatory or terminal stage of shock:

Answer 28

autoregulation fails | sympathetic control lost

Question 29

how do cats differ?

Answer 29

``` cats often skip the decompensatory stage: bradycardia hypothermia hypoglycemia hypotension ``` smaller blood volume than dog

Question 30

overall approach to shock?

Answer 30

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

Question 31

overall general signs of shock?

Answer 31

- pallor - tachycardia - dull mentation - cool extremities - poor pulse quality

Question 32

use of pressors?

Answer 32

inc SVR

Question 33

use of chronotropes?

Answer 33

inc HR

Question 34

use of fluids?

Answer 34

inc preload correct hypovolemia correct hemoconcentration reverse/maintain hydration

Question 35

use of vasodilators?

Answer 35

reduce afterload

Question 36

use of contractility?

Answer 36

inc strength of contraction

Question 37

RBC transfusion?

Answer 37

inc Hb (o2 carrying capacity)

Question 38

o2 therapy?

Answer 38

inc dissolved o2

Question 39

monitor parameters for shock: in order of clinical applicability?

Answer 39

``` mentation MM color CRT HR pulse quality blood pressure urine output CVP acid-base ```

Question 40

upper limit for shock dose of crystalloid? purpose?

Answer 40

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

Question 41

upper limit for colloid? purpose?

Answer 41

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

Question 42

hypertonic saline upper limit dose?

Answer 42

4 mL/kg bolus uncommon to use

Question 43

when to give crystalloid?

Answer 43

dehydrated has kidney fxn intact brain, lungs

Question 44

when to give colloid?

Answer 44

normal hydration less volume desired hypoproteinemic

Question 45

major drugs for ionotropic and pressor support? what is route of administration?

Answer 45

dobutabmine: ionotrope dopamine: low dose is ionotrope high dose is pressor IV CRI administration

Question 46

what is SIRS?

Answer 46

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

Question 47

major cytokines in SIRS?

Answer 47

``` IL 1 IL 6 IL 8 TNF a platelet activating factor ```

Question 48

what end points should you give fluids to?

Answer 48

- blood pressure - urine output - CVP - acid base parameters (base deficit, lactate)

Question 49

how is MODS caused?

Answer 49

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

Question 50

which are the target cells for SIRS?

Answer 50

WBC platelet endothelial cells

Question 51

define MODS?

Answer 51

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

Question 52

what are SIRS criteria?

Answer 52

- hyper or hypothermia - tachycardia - tachypnea - respiratory alkalosis (low PaCo2) - leukocytosis or leukopenia (left shift)

Question 53

SIRS tx?

Answer 53

- 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

Question 54

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

Answer 54

dec crystalloid dose by half the normal dose

Question 55

some etiology of infectious SIRS?

Answer 55

``` pyometra prostatitis pyelonephritis peritonitis pneumonia pancreatitis ```

Question 56

some non infectious etiology of SIRS?

Answer 56

``` neoplasia heat stroke severe burns severe trauma snake envenomation ```

Question 57

steps to SIRS:

Answer 57

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