Flashcards in SA Fluids (MR) Deck (74):
Definition of Shock?
The state in which profound and widespread reduction of effective tissue perfusion leads first to reversible, and then, if prolonged, to irreversible cellular injury
How often is just one type of shock occurring?
Anatomic Shock Classification: List types?
Cardiogenic (heart) - CO output problem
Hypovolemic (blood) - Volume loss
Obstructive (vessels) - Ex. GDV massive pressure collapse of vena cava
Distributive (vessels) - Massive Vasodialation - Anaphylaxis
How will you recognize Compensated Shock?
Mild increases HR/RR
Normal mentation and blood pressure
Maybe 'brick red' MM
CRT < 1 s in some forms
Early Decompensated Clinical Signs?
Pale MM - peripheral vasoconstriction
Weak pulse quality
Terminal (Decompensated) Clinical Signs?
Low HR in spite of low CO
The Adaptive Response to shock?
Renin-Angiotensin- Aldosterone secretion
Selective Vasoconstriction to preserve vital organ function - increase profussion
Progression of Shock Syndrome: The adaptive response requires what?
↑ energy/oxygen consumption
The adaptive response is eventually?
Results in progressive decline in cardiovascular function
Shock syndromes requiring fluid resuscitation?
Which shock type would fluids probably not be helpful?
Are cats small dogs?
Feline shock patients are different how?
Hypothermia and hypotension predominate
Bradycardia rather than tachycardia
Hypothermia - decreases ability to cope with fluid load
Begin resuscitation but do not 'blast' a cat with fluids until you determine their response to rewarming
What do you give to ↑ Preload?
What do you give to ↑ SV Afterload?
What do you give to ↑contractibility?
Effective fluid resuscitation restores what?
Total Body Water ___% of BW?
Intracellular is ____% of total body water?
% Total Body Weight?
Extracellular Fluid is ___% of total body water?
% Total Body Weight?
• Intravascular is ___% of ECF?
% Total Body Weight?
• Interstitial is ___% of ECF?
% Total Body Weight?
Total Body Water = 66%
Total Body Weight = 40%
Total Body Water =33%
Total Body Weight = 20%
• Intravascular (ECF):
% of ECF - Body Water ECF = 25%
% of ECF - Body Weight = 4%
• Interstitial (ECF)
% of ECF - Body Water = 75%
% of ECF - Body Weight = 16%
Crystalloids are made of what?
salt or sugar solutions of varying concentration
Crystalloid solutions are not restricted by?
Where do they equilibrate between?
Interstitial and Intravascular Spaces
Crystalloids have their Primary effect in _____________ space?
After 20 - 30 min, how much Crystalloid is still in Intravascular Space?
Osmolality of fluid determines what?
Power to draw fluid from interstitial and intracellular spaces
Duration of effect of fluids determined by?
Underlying hydration/electrolyte balance
Renal handling of water/electrolytes
Hypertonic saline (5-7%) expands intravascular space by ___ times the volume for short duration?
Isotonic Crystalloid Behavior:
Distribution to Intravascular and Interstitial Fluids ___% remains in Intravascular Fluid after 20 - 30 min?
What are the two conditions you will 1st consider to decide upon which fluids to give?
When these conflict how do you decide?
Acid/Base Balance Status
What are they going to die from first!
Which are the Acidifying crystalloids?
0.9% NaCl (Saline)
TQ!!! Which are the Alkalinizing solutions?
Which is the MOST alkanizing?
Lactated Ringer's Solution (LRS)
*******Plasmalyte-148 (P-148)/Normosol-R (Norm-R)******
TQ!!! What is the most common acid/base disturbance in dogs & cats?
A: Higher Na and Cl
Very compatible - no Ca2+
D: Higher Na and Cl
Poor buffering ability (bad for acidosis)
If a fluid has Ca2+ when can you NEVER use it?
A: Great buffer for acidic situations
More physiologically normal Cl-
D: Ca2+ reactivity
Na concentration (low)
Lactate (HCO3- precursor) - doesn't seem to matter clinically
P-148 or Norm-R Advantages?
A: Increased buffer
Non liver buffers
D: Increased buffer - maybe too buffering
What are Hypotonic Fluids available? (3)
How often will you give these alone?
Dextrose in Water (D5W)
0.45% NaCl (Half-strength saline)
0.45% NaCl with 2.5%
Dextrose VERY RARELY!
How does your body handle the dextrose?
Metabolizes the dextrose, essentially giving free water
Hypotonic Effect: What is the danger in giving free water?
Electrolyte imbalance/Osmolality issues
Should D5W be used as a 1º fluid?
How will it most often be used?
As fluid for dilution of medications or other fluids
Half-strength Saline Indications?
Correct slowly (if chronic) 0.5 mEq/L/hr
Complication: Cerebral edema
Patients with Na intolerance?
End stage renal disease
End stage liver disease
Colloids are solutions with large macromolecules, movement is restricted by?
Primary effect of colloids is?
volume expansion of vascular space
Colloid solutions contribute predominantly to ________ pressure?
Major volume draws of Colloids?
Colloid Osmotic Pressure (COP)*** (most) Pressure
Gibbs-Donan Effect = Negative charges attract Na/H20
- negative charges draw water twd them (minor )
Hetastarth has ___ X volume expansion?
100 ml expands to 140 ml
Natural Colloids Available?
Whole Blood 25%
Albumin (human) - allergic rxns - not common
Synthetic Colloids Available?
Synthetic Dextran 70 (Dex-70)
Hetastarch (HES) - most common
A: Molecular size
Duration of action - works longer
D: Hemostasis effects - coagulopathies due to dilution
Doesn't expire quickly
NO scavenging $$$
Duration of effect
Potent volume expansion
What is important to ALWAYS remember when doing fluid therapy?
Titration to effect
No 2 animals/cases are alike
TQ!!! What are the Isotonic Crystalloid shock doses for dog and cat?
Dog Dose (mL/kg) = 80-90
Cat Dose (mL/kg) = 40-50
TQ!!! What are the Hetastarch (6%) shock doses for dog and cat?
K9 Dose (mL/kg) = 20
Fe Dose (mL/kg) = 10-15
Total Blood Volume for Dogs?
8-9% of BW dog (80-90 mL/kg)
5-6% of BW cat (50-60 mL/kg)
Signs of shock detectable when ____ % blood volume loss?
Mild signs (compensated shock) __________% loss?
Moderate signs (early decompensated) _______ loss?
TQ!!! What is rule for giving shock does?
Give ¼ - 1/3 of shock dose Bolus and then reassess!
Developing A Plan: what do you ask first?
Do they need rescuscitation/shock dose?
Resuscitation Phase parameters?
Estimating Dehydration: subclinical?
6-8% mild with no cardiovascular signs
8-10% moderate with minor cardiovascular signs
10-12% severe with signs of hypovolemic shock
12-15% severe, moribund
Replace sensible and insensible losses based on?
Body Mass:Surface Area
Use maintenance fluid chart
(no chart available): 60 ml/kg/day****
Volume of GI losses usually underestimated by?
What is normal urine production?
When should urine be considered in ongoing losses?
>2 mL/kg/hr is ongoing loss
TQ!!! Maximum for KCl administration?
Why is it toxic?
Potassium affects RESTING potential
What does Ca2+ affect?
To correct fluid loss due to dysfunction of preload what should be given?
To correct fluid loss due to dysfunction of contractibility what should be given?
To correct fluid loss due to dysfunction of afterload what should be given?
Speed of replacement for dehydration?
What is most physiological?
Rapid or over 24hr
What are rehydration needs?
Target for shock dose for Crystalloids is to expand blood volume by ____%?
Dog = ______mL/kg
Cat = ______mL/kg
30 mL/kg DOG
20 mL/kg CAT
When giving shock fluids should you think dose or rate?
Colloid Expanding effect depends on (2)?
1. Intact Endothelium
2. Presence of interstitial fluid