Midterm Flashcards
(199 cards)
1
Q
Define CPR
A
Emergence procedure performed in order to manually maintain perfusion until spontaneous circulation can be restored
2
Q
Define CPA (cardiopulmonary arrest)
A
Cessation of normal circulation due to failure of the heart to contract effectively
3
Q
What is the biggest influence on whether CPR will work or not
A
If CPA does not have a reversible cause, CPR is unlikely to be successful - example, if it is due to anesthesia it is likely reversible, if it is due to a terminal disease, it probably is not
4
Q
What is the success rate of CRR
A
5%
5
Q
What are 3 key features in recognizing CPR
A
Loss of consciousness, loss of normal spontaneous breathing, loss of palpable pulses
6
Q
What are common preceding events to CPR
A
Bradycardia, worsening mentation, sudden increase in vagal tone (vomiting, straining to defecate), sudden change in breathing pattern
7
Q
Which pose are you going to feel if concerned about CPA
A
Femoral pulses
8
Q
What are common diseases that predispose to CPA, warranting intense monitoring and aggressive therapy
A
Sepsis, sirs , heart failure , pulmonary disease, trauma, neoplasia, general anesthesia
9
Q
What are the 6 roles of a CPR crash team
A
Leader, ventilator, compressor, time keeper, recorder, drug administrator
10
Q
When performing CPR, do you follow the ABC rule (airway, breathing , circulation)
A
No - start compressions immediately before securing airway (because it takes too long together supplies ) - it is circulation , airway and breathing
11
Q
How many breaths per minute do you give when patient is intubated and you are giving manual breaths
A
8-12 breaths/minute
12
Q
What amount of oxygen do you use when giving manual breaths
A
100% oxygen
13
Q
What is our ultimate goal in CPR
A
Get the heart beating again _ we con manually give breaths for while but without circulation it doesn’t matter
14
Q
When do you use the thoracic pump theory in CPR
A
Over 15 kg dog, wide chest
15
Q
When do you use the cardiac pump theory
A
Less than 15 kg
16
Q
How many compressions per minute do you do with CPR
A
100 compressions per minute
17
Q
How do you give chest compressions
A
Depress the chest by one third then allow complete chest recoil to allow venous blood return to heart
18
Q
When is open chest CPR indicated
A
Large dogs with thoracic trauma, pleural or pericardial disease, intra operative arrest, ineffective chest compressions
19
Q
If you are successful with open chest CPR I what do you need to be prepared for
A
Thoracotomy - cut into the there to reach lungs or other organs
20
Q
What are examples of pleural or pericardial disease that would indicate open chest CPR
A
Pneumothorax, pleural or pericardial effusion, diaphragmatic hernia
21
Q
What are the 4 recognized arrest rhythms
A
Ventricular tachycardia, ventricular fibrillation, systole, pulseless electrical activity
22
Q
What are the two shockable rhythms
A
Ventricular fibrillation and pulse less ventricular tachycardia
23
Q
Is the goal of defibrillation to start the heart again
A
No - goal is to shut down the electrical activity to let the heart and sinus node do its thing
24
Q
What is the shock dose for external defibrillation
A
2-10 joules/ kg
25
What position is the dog in when you do defibrillation
Dorsal
26
How long after defibrillation do you recheck the rhythm
2 minutes
27
What is the most common CPR drug used and how is it given
Epinephrine - give IV at 1 ml/10 kg every 4 minutes
28
When would no use atropine in a CPA
Before arrest for bradycardia - give 1ml/10kg IV
29
What 2 things do you monitor with CPA
ECG and end tidal co2
30
What does end tital co2 tell you during CPA
Confirms ET tube placement and identifies ROSC (return to spontaneous circulation) I also assesses quality of CPR compressions
31
When do you give fluids during a CPA
Only if the patient was hypovolemic prior to arrest - otherwise can reduce coronary perfusion
32
Do yo use antiarrhytmic agents like lidocaine in CPA
no - can decrease success of defibrillation and suppress ventricular activity
33
How do you assess brain function during triage
Mention - due, stuporous , comatose, death. And if patient is seizing
34
What is the difference between dull and stuporous and comatose
Dull - responds to all stimuli with less Vigor,
Stuporous - only responds to noxious stimuli
Comatose - no response to noxious stimuli
35
How do you check lung function with triage
Breathing rate and effort , abdominal effort on expiration , neck extension, stressed look
36
Do we care about crackles or where's on triage exam
No
37
What is the only cause for panting in dog
Thermoregulation - trying to cool off
38
What do you check on triage to assess perfusion
Heart rate , mm, CRT, mention, temperature, pulse quality, thermometer!
39
On cardiovascular triage, we are looking for - in dogs and - in cats
Tachycardia in dogs (60 - 120 bpm), bradycardia in-cats (180 - 240 bom)
40
When do cats usually become bradycardic
When in shock and decompensating
41
When there is low perfusion ( in dogs especially) , what is the first thing the body does
Heart rate increases
42
Where does gum color come from
Hemoglobin
43
What do mm colors indicate - pink, red, brown, blue yellow, white
Pink - enough hemoglobin
Red -oxyhemoglobin
Brown - toxins leading to methemoglobin
Blue - deoxhemoslobin (no oxygen bonding to hemoglobin)
Yellow - bilirubin which is a by product of hemoglobin break down
While - decreased hemoglobin (anemia or vasoconstriction)
44
What is CRT look like with vasoconstriction? Vasodilation?
Over 2 seconds with vasoconstriction
Les than one second with vasodilation
45
How can mentation indicate perfusion
Brain reeds ouch and sugar to work (gets these by blood fow) - correct perfusion then reassess the mention
46
Poor mention in the absence of other neuro signs indicates
Poor perfusion
47
How can temperature indicate perfusion
Hypothermia concerning - when cold you vasoconstrictor and when u vasoconstriction you get cold (shunt blood away from periphery to maintain blood now to the core organs)
48
A low body temp and cold toes can indicate
Perfusion problems
49
Describe weak pulse
Distance between systole and diastole is shortened - less volume per bolus
50
Define shock
Severe imbalance between oxygen supply and demand, leading to inadequate cellar energy production significant decrease in oxygen supply to tissues or an overconsumption of oxygen
51
Shock is a balance between
Oxygen deliver and oxygen consumption
52
Oxygen delivery = - x -
Cardiac output times arterial content of exigen
53
What does art trial content of oxygen mean
How much oxygen is in the bloodstream
54
What are the 3 types of shock
Circulatory, hypoxic, metabolic
55
What are the types of circulatory shock
Hypovolemic, distributive, obstructive, cardigenic
56
The majority of shocks are - and due to
Most are circulatory and due to decreased oxygen delivery
57
What's the most common type of circulatory shock? Describe it
Hypovolemic - decreased intravascular volume, decreased preload, decreased cardiac output
58
What are causes of hypovolemic shock
Hemorrhage, severe dehydration (GI or renal losses), third space fluid loss, severe burns (loss of proteins and electrolytes)
59
Describe distributive shock
Mal distribution of fluid from changes in vascular tone and increased vascular permeability (there is enough volume but it is not getting to the tissues , decreased systemic vascular resistance (deficits in preload or contractiling)
60
What are causes of distributive shocks
Anaphylactic Shock ( histamine induced vasodilation) , septic shock (endothelial dysfunction) , neurogenic shock, extreme fear
61
Describe obstructive shock
Compression of heart or great vessel that interferes with venous return, decreased diastolic filling and preload, decreased cardiac output
62
What are causes of obstructive shock
GDV ,obstruction of vena cava ,tension pneumothorax, cardiac tamponade from periodical effusion, positive pressure ventilation
63
When there is pericardial effusion and increased pressure over the heart - which part of the heart collapses first
The right atrium (least pressure)
64
Describe cardiogenic shock
Decrease in forward flow from heart due to pump failure - primer decrease in cardiac output due to an issue with the heart and tie pump failure
65
What are causes of cardiogenic shock
Systolic failure (dcm), diastolic failure (hcm), atrioventricular valve degeneration, Brady or tachy arrhythmias
66
Describe hypoxia shock - what are causes
Decreased arterial oxygen content and decreased oxygen deliver to tissues - caused by severe pulmonary disease, anemia, dyshemoglobinemias
67
Describe metabolic shock and its causes
Deranged cellular metabolism leading to inappropriate oxygen tissue use due to severe hypoglycemia and mitochondrial dysfunction
68
What do catecholimines cause
Increased heart rate, contractility and peripheral vasoconstriction
69
What are 4 compensatory mechanisms of shock
Barocreceptor reflex, chemoreceptors I RAA S activation, antdiruetic hormone
70
- Is often considered hallmark for decompensatory shock
Hypotension - map determines peripheral perfusion
71
What ave 2 types of distributive shock? Describe them
Anaphylactic and septic - initial vasodilation then vasoconstriction
72
What are clinical signs of anaphylactic or septic shock
Tachycardia, CRT less than 1second (because of the vasodilation), red to injected mucus membranes , elevated temp, bounding pulses
73
, Bradycardia in cats is - until proven other wise
Shock
74
What is the shock organ for dogs? For cats?
Dogs - git
Cats - lung
75
Hypothermia in dogs indicates what type of shock
Crudiogenic - in cats it can indicate any type of shock
76
What is the goal of shock treatment
Restore oxygen delivery to tissues as soon as possible - flow by oxygen, obtain IV access, IV find bolus UNLESS in cordiogenic shock
77
What are indications for peripheral venous catheters
Emergency like CPA, fluid admin, sedation , euthanasia
78
When do you often place auricular catheters
Mostly GDVs
79
What type of catheter is best for fluid administratrion and blood products especially in shock patients
Large bore, short catheters
80
What is the purpose of venous cut down for peripheral venous catheters
Temporary utilization to provide fluid resuscitation until routine peripheral venous catheter can be more readily replaced - emergency situations to provide stability with fluids or blood products
81
What should you do after rending venous cut down catheters
Contaminated nature of catheter placement means you need to lavage and close aseptically
82
Where is venous cut down done in dog? Cat?
Lateral saphenous dog, medial saphenous cat
83
Define phlebitis
Inflammation of a vein near the surface of the skin
84
If you have a dog with a fever and a catheter who is otherwise doing well, what should you do
Change the catheter in case of phlebitis
85
When do you place intraosseous catheters and where
Small or neonatal patients, exotics, failure for peripheral venous catheter - placed in femoral or humeral or tibia
86
Describe the efficacy of intraosseous catheters
Slower onset of drug admin, is for fluid resuscitation until venous peripheral access can be had, quicker time to place a venous cut down , blood samples less accurate because it is from bone marrow
87
What is the Max time an intraosseuos catheter should be placed
24 hard max
88
When are intermittent uincy catheters best
For contrast procedures or to relieve an obstruction
89
When should you prescribe antibiotics in emergency
Know bacterial infection that has positive culture or suspected bacterial infection (due to signs like a fever, information)
90
Does fever mean infection
No - fever means inflammation (not all inflammation is caused by an infection)
91
Should you give antibiotics for upper respiratory tract infections
No-usually is due to a virus with secondary bacterial infection
92
Should you give febrile patients antibiotics
Sometime but usually it is due to viral infections
93
What are the 5 classes of analgesics used in the Er
Opioids, NSAIDs, alpha 2 agonists, NMDA receptor antagonists, local anesthetics
94
What are pros of opioids
Excellent analgesia , minimal cardiovascular effects, reversible, sedation
95
How do you reverse opioids
Naloxone
96
Opioids in an Er setting are good for dogs with - and -
Safe for shock dogs and congestive heart failure due to the minimal cardiovascular effects
97
What are the cons of opioids in Er patients
Possible respirators depression, parental primary (oral bioavailability low), sedation, abuse, GI upset and illus
98
Summarize the use of opioids in Er and the time limit
Good analgesic for acute, severe pain , safe and effective but is not good for chronic use (max 24-48 hour use)
99
Stop opioids at 48 hours max due to
Adverse GI effects
100
What are the pros of NSAIDs
Excellent analgesia , .oral and parental, inexpensive
101
What are the cons of NSAIDs
Possible GI ulceration, no use in dehydrated or hypovolemic patients due to decreased renal blue flow and not reversible
102
What is the reversal for NSAIDs
No reversal
103
If an animal is on NSAIDs and they stop eating , what should you do
Stop the NSAIDs became if they aren't eating , they aren't drinking so it is not safe
104
Immediately after trauma, would you start a dog on NSAIDs
No - you reed to make sure renal perfusion is good first
105
How do NSAIDs affect the kidneys
Renal autoregulation is mediated by prostaglandins and NSAIDs block prostaglandin production so during a trauma the kidneys are not able to adjust in the face of hypotension (leaves the kidneys unprotected)
106
How do NSAIDs affect git and stomach
They block prostaglandins that lead the gut to be more susceptible to ulcer formation (prostagladino importat to make mucus buffers and secrete more bicarb)
107
Summarize NSAIDs
Excellent analgesia for severe, chronic and orthopedic pain contraindicated in dehydration and hypovolemia (big risk of renal damage ) I risk of GI upset and ulcers
108
When do you use NSAIDs generally? Can you give them on an empty
If patient is well hydrated and perfusing well for both qs
109
What are pros of alpha 2 agonists
Effective analgesia, powerful sedation, cheap, reversible
110
What are the cons of alpha 2 agonists
Significant decrease in cardiac output so limit use to very stable patients, profund sedation , respiratory depression, parental only
111
What can be the risk with the profound sedation seen by alpha 2 agonists
Decreases ability to detect pain in Er patients
112
Is dexmedetonidine a good option for patients with decreased cardiovascular status
No - significant decrease in cardiac output
113
Does a lower dose of dexmedetomidine (an alpha 2 agonist) men it is safer for heart patients
No - no matter the dose there is always a 60-70% drop in cardiac output; it is a yes or no drug -i either the patient is stable enough or not
114
What is an example of NMDA receptor agonist
Ketamine
115
When are NMDA receptor antagonists best
Most effective if given before the painful stimulus (like if you give before surgery)
116
What are the beeline of NMDA receptor antagonists
Reduces amount of opioids needed for analgesia, prevent windup can increase in pain intensity caused by the same stimulus over time
117
What is a pro of NMDA receptor antagonists
Minimal to no GI effects so good for severe pain and GI signs
118
What is the main stay therapy for shock patients
Fluid resuscitation with isotonic crystolloids like LRS IV over 10-20 minutes, then immediate reassessment after bonus , whole blood if bleeding or blood loss
119
What are treatments for obstructive shock patients (a subcategory of distributive shock)
Gashed trocharization, thoracocentesis , pericordiocentesis (relieve pressure causing the obstruction)
120
What ave quick treatments for patients in septic shock
Vasopressors like norepinephrine, broad spectrum antibiotics, fluids
121
How do you treat anaphylactic shock
Vasopressers like epinephrine, antihistamines, fluids
122
What would you not use to treat cardiogenic shock? What do youdo?
No IV fluids! Correct underlying disease, oxygen therapy, minimize stress
123
How do you treat chf leading to cardiogenic shock
Diuretics like furosemide , oxygen therapy
124
How do you treat life threatening arrhythmias leading to cardiogenic shock
Lidocaine or atropine
125
What are your resuscitation endpoints for shock therapy
Clinical reassessment every 5 to 10 minutes or after every therapy used during stabilization - can desolate after normal perfusion parameters are reached
126
What is the most sensitive indicator of Shock
Heart rate
127
When triaging, what is usually the easiest pulses to feel
Femoral pulses
128
What is the most common shock in poly trauma patients
Hemorrhagic shock - tissue hypopefusion due to decreased cardiac output and decreased mean arterial pressure
129
What do you look for first in poly trauma patients
Check lactate, tissue perfusion, signs of hemorrhagic shock (heart rate, mm, etc)
130
What is the goal of IV fluid resuscitation
Restore tissue perfusion and oxygen delivery
131
Crystalloids are a-
Balanced electrolyte solution
132
A benefit of colloids is that they stay
In the intravascuor space longer
133
What is point of care ultrasonography
Abdominal fast scans Or thoracic fast scans
134
What are benefit of pocus
Portable and we don't need a radiologist to interpret, fast, can be done while other tests are being done
135
What is the ultimate goat of fast scans
To see if there is free fluid in the thorax or abdomen and tren use as a guide for procedures like thoracocentesis, pericordiocentesis, etc
136
Why is performing A fast in right lateral best
Decreased risk of hitting the spleen if aspirating - dorsal recumbency bad for patients with respiratory distress
137
What is important to check for on an afast especially after trauma
Check to make sure the bladder is intact
138
What are the 4 views to check on an afast
Diaphragmatic hepatic, spleen renal, cysto colic, hepatorenal
139
How do you use abdominal fluid scores
Purpose is to gauge severity of abdominal effusions - a score of I men's file seen in to 4 sites and so on (this score should correlate with CBC, PCI, etc)
140
How often should you repeat afast scans and scores
Every 4 hours (even hour if patient is shock)
141
Lung rockets on tfasf scans indicate what
Lung contusions, wet lung, some sort of interstitial disease
142
Bar code signs on M mode on TFast could indicate
Pneumothorax
143
Rain sign on m mode for tfast could indicate what
Wet lung or interstitial disease
144
What is the benefit of a mushroom view on tfast
To see heart function and contractility
145
What size should the left atrium be compared to the aorta on tfast
Left atrium should be 1- 1.5 times the size of the aorta (if bigger left atrial enlargement)
146
Define orthopnea
Positional increases in difficulty breathing - head and reck extended, elbows abducted (basically trying to extend path of breathing)
147
Define dyspnea
Sensation of breathless
148
Issues breathing on inspiration localize the problem to where
Upper respiratory
149
Issues on expiratory breathing indicates a problem where
Lower airway like bronchial disease
150
Where is the problem localized to with increased effort during all breathing phases
Parenchymal
151
Short shallow breathing localizes the problem to where
Pleural space
152
What are 3 things to do over a patient is in respiratory distress
Minimize stress , oxygen supplementation, provide sedation (butorphanol usually) - it patient is really bad I con heavily sedate and intubate to reduce stress and the work of breathing
153
It is better to - a living patient in respiratory distress than to
Better to intimate a living patient than a head patient who just went into respiratory arrest
154
What ave possible upper airway diseases that can cause issues on inspiration
Laryngeal paralysis , tracheal collapse, foreign bodies, polyps, brachycephalic airway syndrome
155
What can help you differentiate between cardiac and non cardiac caused
Temperature - if congestive heart failure, they should be hypothermic
156
What are the 3 fluid compartments in the body
Intracellular fluid, extracellular (interstial and intravascular)
157
What is the total body water
65% (multiply body weight by 0.65 )
158
Describe the relationship between sodium and potassium intracellularly and extracellularly
Inside the cell, there is low sodium and high potassium, outside the cell there is high sodium and low potassium
159
What determines intravascular concentration
Sodium because water follows sodium
160
Total body sodium determines
Hydration
161
Serum sodium concentration reflects - not-
Reflects total body water not total body sodium because water is freely permeable across cell membranes and sodium is not
162
High sodium on bloodwork lovely means -
Low water and vice versa
163
Huponatrenia indicates a-
Water excess -losing both water and electrolytes like sodium
164
What does the sodium in a dehydrated animal usually look like
Normal or high sodium - depends on if losing water in excess or Normal amount
165
Hypernatronic indicates a
Water deficit - severely dehydrated
166
Hypotonic loss means
More water is lost than solute loss - usually with a polyuric patient, can lead to a huperatrenia
167
A hypertonic loss means what
More solute is lost than water, could lead to a hyponatremia
168
Fluid loss is most often
Isotonic and the sodium remains unchanged - isotonic to extracellular fluid
169
Differentiate between dehydration and hypovolemia
Dehydration - loss of fluid from the interstitial space, happens slow and replaced slow
Hypovolenia - loss of fluid from the intravascular space happens rapidly
170
Where do the losses occur with dehydration and hypovolemia
Extracellular comportment - interstitial (dehydration) and intravascular (hypovolemia)
171
Which type of fluid loss requires rapid restoration and why
Hypovolemia fluid loss from the intravascular space - because the body can't quickly replace the fluid
172
A gradual fluid loss or lack of replacement indicates
Dehydration and lack of interstitial water
173
What general type of replacement said do you need for dehydration and hypovolemia and why
High sodium because these are both extracelluar fluid losses so losing high sodium and low potassium
174
What are 6 reasons to give fluids
Dehydration, hypovolemia, anorexia over 24 hours, severe losses, general anesthesia , as a vehicle to get other stuff in the patient
175
What are the main 2 reasons to give finds
Dehydration and hypovolemia
176
If an animal has diarrhea and they are eating/ drinking , will they need fluids
No -if eating will be drinking
177
What are crystalloids
Salt water - moves freely within extracellular space and redistributes rapidly into interstium
178
What are colloids
Contains molecules that don't readily leave the intravascular space so should stay in the intravascular space, (more than salt in the water)
179
All fluids will redistribute in the first - but - distributes faster
All fluid will redistribute in the first few hourrs - crystalloids redistribute faster
180
The greatest absolute increase in blood volume is seen with - while the greatest increase in blood volume per volume delivered is seen with -
Crystalloids lead to greatest absolute volume increase, hypertonic saline leads to greatest increase in blood volume per volume
181
The most sustained increase in blood volume is seen with
Colloids - because colloids stay in the intravascular space longer
182
What are risks of colloids
Potential interstitial leak leading to edema , changes incoagulation, kidney injury, more expensive than crystalloids
183
What are risks of crystalloids
Large volume, transient effect, potentates edema
184
Give examples of isotonic fluid
LRS , normal saline, normosol R, plasma lyte A
185
Describe isotonic fluids
Same amount salt as extracellular fluid
186
Describe hypotonic fluids - what is important to note about them
Less salt than Extracellular fluid - can never bolus hypotonic finds became too much water can cause cells to explode
187
Describe hyper tonic saline
Plus free water fromn interstitial and intracellaar spaces to increase the intravascular volume - excess salt compared to fluid
188
When should you avoid using hypertonic fluids
Hypernatremic or dehydrated patients - because it could make the hypernatremia worse
189
What are benefits of hypertonic fluids
Increased tissue oxygen delivery, sustain heart rate and cardiac output, decreased cellular edema
190
You should have lower - man - in extracellular fluid
Lower chloride than sodium in Extracellular fluid
191
Describe replacement fluid and give examples
Mimics extracellar fluid, high in sodium - lactated ringers, normal saline , normosol r, plasmalyte
192
Describe maintenance fluids and give examples
Mimics daily electrolyte requirements , low in sodium and chloride higher in potassium - half strength saline , normosol m
193
When are sub Q fluids appropriate
Only in stable patients
194
How does the baroreceptors reflex compensate for shock
Changes in pressure lead to increased heart rate and contraction, and peripheral vasoconstriction
195
How do chemoreceptors compensate for shock
Chases in things like pH or po2 need to increased respiratory rate and tidal volume - the bigger breaths to increase oxygen delivery to tissues
196
How does RAAS activation compensate for shock
Increases angiotensin 2 (a potent vasoconstricter) to increase peripheral vasoconstriction and increase real sodium absorption (because water follows sodium)
197
How does antidiuretic hormone compensate or shock
Increases renal water absorption
198
Describe decompensatory shock
Decreased blood pressure and decreased heart rate
199
Describe compensatory shock
Increased heart rate and normal blood pressure
