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Misc Flashcards

1
Q

SIRS

A

-Systemic inflammatory response syndrome
-clinical state of systemic inflammation

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2
Q

Causes of SIRS

A

-Infectious
-Non-infectious (panky, polytrauma, burns, heatstroke, neoplasia, immune-mediated disease, post-op)

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3
Q

SIRS criteria

A

Diagnosis of SIRS consist of fulfilling 2 out of the following 4 criteria in dogs and 3 out of 4 criteria in cats:
(1) increased or decreased temperature
(2) tachycardia (or bradycardia in cats)
(3) tachypnea
(4) leukon abnormalities

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4
Q

Sepsis-2

A
  • categorizes patients into 3 groups: sepsis, severe sepsis, septic shock based on the presence of infection, SIRS, MODS, and refractory hypotension
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5
Q

Sepsis-3

A

-Categorizes patients into 2 groups (sepsis and septic shock) based on the presence of infection with organ dysfunction, refractory hypotension, and persistently increased lactate despite appropriate resuscitation
-Selects for patients with more severe cases of sepsis and higher risk of death compared to Sepsis-2

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6
Q

Branched amino acids

A

leucine, isoleucine, valine

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7
Q

Gq receptors

A

-activates IP3, DAG
-Alpha 1, endothelin, V1, M1, M3, M5, H1

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8
Q

Gs receptors

A

Activates cAMP -> PKA
- B1
-B2
-V2
-Adenosine
-H2
-glucagon

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9
Q

Gi receptors

A

-prevents conversion to cAMP
-M2
-M4
-alpha 2
-opioids
-D2
-Somatostatin
-GABA b

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10
Q

Metabolic derangements seen with refeeding syndrome

A

Hypophosphatemia, hypomagnesemia, hypokalemia, hyponatremia, hypocalcemia, hyperglycemia, and vitamin deficiencies

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11
Q

Processes body uses to maintain acid-base balance

A

1) regulation of PCO2 by alveolar ventilation
2) buffering of acids by bicarbonate and non- bicarbonate buffers
3) changes in renal excretion of acid or base

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12
Q

Traditional acid base approach

A

Uses the Henderson - hasselbach equation for carbonic acid and uses pH, PCO2, and bicarb concentration.

PH has a direct relationship with bicarb concentration and an inverse relationship with PCO2

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13
Q

Purpose of anion gap

A

To identify the cause of a metabolic acidosis

Unmeasured anions are more abundant than unmeasured cations, the AG is essentially a marker of the amount of unmeasured cations

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14
Q

Measured cations

A

Sodium, potassium

Account for 95% total cations

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15
Q

Measured anions

A

Bicarb, chloride

Accounts for 85% total anions

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16
Q

Unmeasured cations

A

Albumin, lactate, phosphates, sulfates, ketones

Some drugs and toxins can also account for it, including methanol, salicylate, and ethylene glycol

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17
Q

Causes of increased ion gap metabolic acidosis

A

DUEL
-DKA
-Uremia
-Ethylene glycol
-Lactic acidosis

-Salicylate, Methanol (toxins)

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18
Q

Causes of hyperchloremic metabolic acidosis

A

-Renal bicarb loss
-GI bicarb loss
-NaCl administration
-Addison’s

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19
Q

Metabolic acidosis

A

Decreased pH, HCO3-, PCO2

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20
Q

Metabolic alkalosis

A

Increased pH, HCO3-, PCO2

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21
Q

Normal anion gap for dogs and cats

A

10-15 mEq/L

> 25 = acidotic

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22
Q

Data Types

A

1) Categorical
-Nomial (order doesnt matter)
-Ordinal (order matters)
Includes: frequencies, proportiins, percentages, pie charts

2) Numerical
-Discrete (counted, not measured)
- Continuous (measured)
Includes: percentiles, means, medians, modes, box plots

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23
Q

Standard error

A

How far is the samole mean likely to be away rrom the actual (population) mean, describes the sampling process

24
Q

Standard deviation

A

Describes the variation within the population/sample, how far an individual is from the population mean

25
Type I errors
False positive Rejection of the null hypothesis when you shouldn't
26
Type II errors
False negative Acceptance of the null hypothesis when you shouldn't
27
Sensitivity
(True positive/ (true + false negative)) x 100
28
Specificity
(True negative/(true positive+ false negative)) x 100
29
PPV
(true positive/ (true positive + false positive)) x 100
30
NPV
(true negative/ (true negative + false negative)) x 100
31
Hospital-associated infection (HAI)
-nosocomial -infectious event diagnosed >48 hours after hospital admission, or more specifically, on or after the third hospital day without proven prior incubation
32
How common are nosocomial events?
-16.3% in dogs -12% in cats
33
True or False: HAIs in ICU are thought to originate either from the patient's own endogenous flora or from exogenous sources
True
34
What bacteria is a serious threat to critically ill animals?
Carbapenem-resistant Enterobacteriaceae
35
36
Massive Blood Transfusion
Replacement of one entire blood volume within 24 h Transfusion of >10 units of packed red blood cells (PRBCs) in 24 h Transfusion of >20 units of PRBCs in 24 h Transfusion of >4 units of PRBCs in 1 h when on-going need is foreseeable Replacement of 50% of total blood volume (TBV) within 3 h.
37
Sepsis
Defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection
38
Septic shock
Subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality.
39
What is a potential complication of parenteral nutrition?
Hyperglycemia
40
SOFA Score
Sequential Organ Failure Assessment -used to assess organ dysfunction in several different ICU settings -correlates with survival -assigns between 0-4 points to each of the 6 individual organ systems (total score 24) -higher scores = worse outcome
41
ATT
Animal Triage Score Higher score = poorer prognosis 6 categories, 18 points total
42
ATT
-Animal Trauma Triage -profusion, cardiac, respiratory, eye/muscle/integument, skeletal, neuro - out of a total of 18 points -higher = more severe -each point increase indicates a 2.3 to 2.6x decrease in survival rate
43
Pain vs Nociception
-Pain is the unpleasant sensory and emotional experience associated with actual or potential tissue damage (conscious experience) -Nociception is the detection of a noxious stimulus at the tissue level by nociceptors (mechanical, thermal, chemical)
44
Inflammatory mediators that induce pain sensation
Bradykinin, prostaglandins, leukotrienes, serotonin, histamine, substance P, thromboxanes, IL, TNF
45
Nociceptive Pathway
-transduction, transmission, modultaion, projection, perception
46
Analgesic effects of transduction
- local anesthetics - opioids - NSAIDs - corticosteroids
47
Analgesic effects on transmission
-local anesthetics -alpha 2 agonist
48
Analgesic effects on modulation
-local anesthetics -alpha 2 agonist -opioids -NSAIDs -benzodiazepines -NMDA antagonist -TCA antidepressants -anticonvulsants
49
Analgesic effects on perception
- general anesthesia - opioids - alpha 2 agonist - benzodiazepines - phenothiazines
50
Complications of transfusion reactions
Infectious versus more commonly non-infectious Non-infectious breaks down into acute (<24 hours) versus delayed Acute non-immune: Transfusion related sepsis Transfusion related circulatory overload (TACO) Metabolic derangements Dilutional coagulopathy Acute immune: Acute hemolytic transfusion reactions Febrile non-hemolytic transfusion reaction Allergic reactions TRALI Delayed non-immune: Iron overload Delayed immune: Delayed hemolytic transfusion reaction Post transfusion purpura Transfusion associated graft versus host disease
51
Incidence of reaction
0-38%
52
TACO
Transfusion associated circulatory overload Acute non-immunologic reaction secondary to increases in blood volume mediated by transfusion -acute respiratory distress -hydrostatic pulmonary edema -occurs within 6 hours of transfusion Evidence of left atrial overload
53
TRALI
Closely mimics taco but is different in the sense that it is a inflammatory trigger that increases capillary permeability and causes exudative pulmonary edema Antigen-antibody reaction in the lungs No prior lung injury No evidence of left attial hypertension
54
TRALI I
No risk factors for ARDS PF < 300 Clear evidence of bilateral pulmonary edema on rads No evidence of left atrial hypertension Onset within 6 hours
55
TRALI II
Similar to type one but also includes patients that are at risk for ARDS
56
TRALI vs TACO
57
CURATIVE guidelines for FATE
Recommend treatment for thrombophylaxis Recommends use of clopidogrel, UFH, LMHW Recommends AGAINST aspirin as the sole anti thrombotic Warfarin should not be used Rivaroxaban recommended Apixaban not mentioned but has shown to be well tolerated in cats

Residency (15 decks)

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