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Flashcards in Fluid Therapy 1 Deck (66)
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1
Q
What % of TBW does fluid make up?
A
60%
2
Q
What % of TBW makes up intracellular vs. extracellular %?
A
Intracellular: 30-40%
Extracellular: 20-30%
3
Q
What are 5 indications for fluid therapy?
A
Decreased intake
Dehydration
Decreased circulating volume
Need for overhydration
Miscellaneous
4
Q
What are 3 reasons for decreased intake of water?
A
Disease: anorexia, gastric reflux
Inability to ingest water: dysphagia, esophageal obstruction, neurologic dysfunciton
Lack of availability: freezing water
5
Q
What are the 4 types of shock?
A
Hypovolemic shock
Vasculogenic shock
Maldistributive shock
Cardiogenic shock
6
Q
In what situation would you need to overhydrate a horse?
A
Intestinal impaction- increases fluid flow to intestinal lumen and softens stool to allow for easier passage
7
Q
What are 7 clinical signs that indicate the need for fluid therapy?
A
Skin turgor
Mucous membranes
Urine production
Sunken eyes
Depression, muscle weakness
Heart rate
Decreased jugular distensibility
8
Q
At what % of dehydration is skin turgor often seen?
A
8-10% dehydration you begin to notice this CS
9
Q
Where should you check skin turgor in adult horses vs. foals?
A
Adult: neck
Foal: eyelid
10
Q
What is the normal skin tent time?
A
<1 sec
11
Q
At what % are dry MM noticed in equine?
A
5-7% dehydration
12
Q
What is noticed about the urine of a dehydrated patient?
A
Decreased urine output and increased urine specific gravity
13
Q
What species are sunken eyes most commonly observed in?
A
Ruminants-not common to see in equine
14
Q
What is noticed about the heart rate in a dehydrated horse?
A
Tachycardia- one of the first parameters to change
15
Q
What are 6 laboratory indicators of dehydration?
A
PCV
TP
BUN/Crea
Albumin
Lactate
Urinalysis
16
Q
What can mask anemia in an equine patient causing underestimation of severity of the disease?
A
Splenic contraction
17
Q
What will you expect the TP to do as an animals %dehydration increases?
A
TP should increase
18
Q
What can hypoproteinemia do to your estimate of % dehydration?
A
Underestimate degree of dehydration
19
Q
What should you keep albumin above?
A
1.5 g/dL
20
Q
What is the only possible cause of hyperalbuminemia?
A
Dehydration
21
Q
What are 6 CS associated with hypovolemic shock?
A
Prolonged CRT
Decreased jugular filling
Tachycardia
Decreased pulse pressure
Cold extremities
Decreased skin turgor
22
Q
What % dehydration is the following patient?
A horse is presented to you with the following:
Skin tent (s): 2 seconds
MM: slightly tacky
CRT: normal
HR: normal
Decreased urine output
A
5%
23
Q
What % dehydration is the following patient? A horse is presented to you with the following:
Skin tent (s): 4 s.
MM: tacky
CRT: 2-3 s.
HR: 40-60 bpm
Decreased arterial BP
A
8%
24
Q
What % dehydration is the following patient? A horse is presented to you with the following:
Skin tent: 5 sec. +
MM: DRY
CRT: > 4 sec.
HR: 60 BPM+
Reduced jugular fill, barely palpable pulse
A
10-12%
25
Q
What % dehydration is the following patient? A horse is presented to you with the following:
Obvious sunken eyes and in a state of shock
A
12-15%- on the verge of death
26
Q
What are the 7 routes of fluid administration?
A
Oral
IV
SubQ
Intra-peritoneal
Rectal
Intraosseous
Intra-cecal
27
Q
What is the most common route of administration of oral fluids in a horse?
A
Nasogastric tube for fluid administration
28
Q
How many L can be administered at once via oral route?
A
6-8L should be targeted at once (can get up to 12-16 L)
29
Q
What is the fluid transit time from the stomach?
A
<30 min
30
Q
What complication commonly benefits from oral administration the most?
A
LI impactions
31
Q
What is the major contraindication of oral fluid administration?
A
Presence of gastric distention, reflux and ileus
32
Q
What is the second most common route of fluid administration?
A
IV route
33
Q
What are the four sites of IV placement?
A
Jugular vein
Lateral thoracic vein
Cephalic vein
Saphenous vein
34
Q
What direction should the catheter be placed?
A
TOWARDS THE HEART
35
Q
What side of the horse are intra-peritoneal fluids administered?
A
Dorsal aspect of left flank
36
Q
What is a major advantage of intra-peritoneal fluids?
A
Potentially large volumes at a rapid rate
37
Q
How should you position a horse receiving rectal fluids?
A
Horse should stand on an incline with head/forelimbs lower than hind end-avoids evacuation reflex of terminal small colon and rectum
38
Q
What is the major concern of intra-osseous fluid administration?
A
Rate at which the fluids can be administered
39
Q
What is the rate of intra-oseous fluid administration limited by?
A
Size of needle-maximum administration is 2L/hr
40
Q
What is the rate limiting step of fluid administration?
A
narrowest diameter in system- 10 G is the rate limiting catheter size
41
Q
What is the length and flow of a 14 G catheter?
A
Length: 5.25 in.
Flow: 13.1 L/hr
42
Q
What is the flow of a 12 G catheter?
A
26.9 L/hr
43
Q
What is the flow of a 10 G catheter?
A
36.5 L/hr
44
Q
What is the typical STAT IV set?
A
8; above horse with 28L/hr gravity flow capacity
45
Q
What is the typical rate of a macrodrip set in equine?
A
10-15 drops/mL
46
Q
What type of material makes up long term catheters?
A
Polyurethane or silicone
47
Q
What type of material makes up short term catheters?
A
Teflon and polyethylene
48
Q
What is the maximum time period that short-term catheters can be kept in?
A
72 hrs.
49
Q
The rate of thrombosis depends on what 6 factors?
A
systemic state of animal
stiffness of catheter- stiffer=more thrombogenic
Size of catheter- larger=more thrombogenic
length of catheter- longer=more thrombogenic
material of catheter- most thrombogenic (polypropylene) least thrombogenic (polyurethane/mila)
Vessel trauma
50
Q
What is the typical acid-base disturbance in horses?
A
Metabolic acidosis
Typically have loss of K and Ca
51
Q
What 3 factors determines the choice of fluid used?
A
Fluid type
fluid tonicity
fluid effect on acid/base status
52
Q
What are the most common type of fluids used in equine medicine?
A
Crystalloids
53
Q
What are examples of crystalloid solutions?
A
LRS
Saline
Normosol (M/R)
Plasmalyte
Dextrose solutions
Bicarbonate solution
54
Q
What % sodium is in the following solutions:
Normal saline
Half-strength saline
Twice stregnth saline
Hypertonic saline
A
0.9%
0.45%
1.8%
7.2%
55
Q
When are colloid solutions used?
A
Increase oncotic force within IV space to retain fluid within that space
56
Q
What specific case are colloids commonly used?
A
Hypoproteinemia
Dextran, hetastarch, plasma, serum are used
57
Q
What is the most common fluid used in equine medicine?
A
LRS
58
Q
What is the most common reason for hypertonic saline use?
A
Emergency resuscitation in hypovolemia
59
Q
What site should hypertonic saline be administered?
A
Jugular catheter
60
Q
What is the MOA of hypertonic saline?
A
fluid shift from intracellular space into ECF space associated w/ increased tonicity
61
Q
What is the direct effect of hypertonic saline?
A
triggering central brain receptor mechanism
62
Q
What is the overall effect of hypertonic saline?
A
Improvement in CO, MABP urine production and decrease in systemic vascular resistance
- do so by increasing preload and decreasing afterload
63
Q
What can be a major complication of hypertonic saline administration?
A
Uncontrolled hemorrhage due to the improved CO
64
Q
Can dehydration be a contraindication for hypertonic saline administration?
A
Not dehydration alone. However- hypertonic dehydration state can be contraindicated for hypertonic saline administration due to the increased swelling in the brain
65
Q
What type of inotropic effect does hypertonic saline have?
A
Negative inotrope-cardiotoxic
66
Q
T/F: shocky patients are severely dehydrated
A
FALSE- shocky patients are severely hypovolemic