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Flashcards in SA Fluids (MR) Deck (74):
1

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

2

How often is just one type of shock occurring?

Not often

3

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

4

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

5

Early Decompensated Clinical Signs?

Tachycardia
Tachypnea
Pale MM - peripheral vasoconstriction
Prolonged CRT
Weak pulse quality
Depressed mentation
Usually Hypothermic
Hypotension

6

Terminal (Decompensated) Clinical Signs?

Low HR in spite of low CO
Absent CRT
Severe hypotension!!!

7

The Adaptive Response to shock?

Neurohormoral Response:
Sympathetic stimulation
Renin-Angiotensin- Aldosterone secretion
Anti-Diuretic Hormone
Selective Vasoconstriction to preserve vital organ function - increase profussion

8

Progression of Shock Syndrome: The adaptive response requires what?

↑ energy/oxygen consumption

9

The adaptive response is eventually?

Self-destructive
Results in progressive decline in cardiovascular function

10

Shock syndromes requiring fluid resuscitation?

1. Hypovolemic
2. Distributive
± vasopressors
± inotropes
3. Obstructive
± surgery
± thrombosis

11

Which shock type would fluids probably not be helpful?

Cardiogenic

12

Are cats small dogs?
Feline shock patients are different how?

NO
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

13

What do you give to ↑ Preload?
What do you give to ↑ SV Afterload?

Volume
Vasopressors

14

What do you give to ↑contractibility?

+ Inotropes

15

Effective fluid resuscitation restores what?

tissue perfusion

16

Total Body Water ___% of BW?

60%

17

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?

Intracellular:
Total Body Water = 66%
Total Body Weight = 40%

Extracellular:
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%


18

Crystalloids are made of what?

salt or sugar solutions of varying concentration

19

Crystalloid solutions are not restricted by?
Where do they equilibrate between?

Endothelium
Interstitial and Intravascular Spaces

20

Crystalloids have their Primary effect in _____________ space?

Interstitial

21

After 20 - 30 min, how much Crystalloid is still in Intravascular Space?

1/3

22

Osmolality of fluid determines what?

Power to draw fluid from interstitial and intracellular spaces

23

Duration of effect of fluids determined by?

Underlying hydration/electrolyte balance
Renal handling of water/electrolytes

24

Hypertonic saline (5-7%) expands intravascular space by ___ times the volume for short duration?

6

25

Isotonic Crystalloid Behavior:
Distribution to Intravascular and Interstitial Fluids ___% remains in Intravascular Fluid after 20 - 30 min?

25%

26

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
Electrolyte Status
What are they going to die from first!

27

Which are the Acidifying crystalloids?

0.9% NaCl (Saline)

28

TQ!!! Which are the Alkalinizing solutions?
Which is the MOST alkanizing?

Lactated Ringer's Solution (LRS)
*******Plasmalyte-148 (P-148)/Normosol-R (Norm-R)******

29

TQ!!! What is the most common acid/base disturbance in dogs & cats?

Metabolic Acidosis

30

Saline Advantages?
Disadvantages?

A: Higher Na and Cl
Very compatible - no Ca2+

D: Higher Na and Cl
Poor buffering ability (bad for acidosis)

31

If a fluid has Ca2+ when can you NEVER use it?

Blood Transfusions

32

LRS Advantages?
Disadvantages?

A: Great buffer for acidic situations
More physiologically normal Cl-
Buffer

D: Ca2+ reactivity
Na concentration (low)
Lactate (HCO3- precursor) - doesn't seem to matter clinically

33

P-148 or Norm-R Advantages?
Disadvantages?

A: Increased buffer
Non liver buffers
Na concentration
Mg
D: Increased buffer - maybe too buffering

34

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!

35

How does your body handle the dextrose?

Metabolizes the dextrose, essentially giving free water

36

Hypotonic Effect: What is the danger in giving free water?

Electrolyte imbalance/Osmolality issues
Cell death
Cerebral edema

37

Should D5W be used as a 1º fluid?
How will it most often be used?

NOPE
As fluid for dilution of medications or other fluids

38

Half-strength Saline Indications?
Complication?

Hypernatremia therapy
Correct slowly (if chronic) 0.5 mEq/L/hr
Complication: Cerebral edema

39

Patients with Na intolerance?

Heart disease
End stage renal disease
End stage liver disease

40

Colloids are solutions with large macromolecules, movement is restricted by?

Healthy Endothelium

41

Primary effect of colloids is?

volume expansion of vascular space

42

Colloid solutions contribute predominantly to ________ pressure?

Oncotic

43

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 )

44

Hetastarth has ___ X volume expansion?

1.4
100 ml expands to 140 ml

45

Natural Colloids Available?

Natural Plasma
Whole Blood 25%
Albumin (human) - allergic rxns - not common

46

Synthetic Colloids Available?

Synthetic Dextran 70 (Dex-70)
Hetastarch (HES) - most common
Pentastarch (PS)
Oxyglobin

47

Hetastarch Advantages?
Disadvantages?

A: Molecular size
Duration of action - works longer
Low Reactivity
D: Hemostasis effects - coagulopathies due to dilution
Cost

48

Oxyglobin Advantages:

Doesn't expire quickly
Oxygen delivery
Volume expansion
No immunoreactivity

49

Oxyglobin Disadvantages:

NO scavenging $$$
Duration of effect
Potent volume expansion

50

What is important to ALWAYS remember when doing fluid therapy?

Titration to effect
No 2 animals/cases are alike

51

TQ!!! What are the Isotonic Crystalloid shock doses for dog and cat?

Dog Dose (mL/kg) = 80-90
Cat Dose (mL/kg) = 40-50

52

TQ!!! What are the Hetastarch (6%) shock doses for dog and cat?

K9 Dose (mL/kg) = 20
Fe Dose (mL/kg) = 10-15

53

Total Blood Volume for Dogs?
Cats?

8-9% of BW dog (80-90 mL/kg)
5-6% of BW cat (50-60 mL/kg)

54

Signs of shock detectable when ____ % blood volume loss?

10-30%

55

Mild signs (compensated shock) __________% loss?

10-15%

56

Moderate signs (early decompensated) _______ loss?

15-30%

57

TQ!!! What is rule for giving shock does?

Give ¼ - 1/3 of shock dose Bolus and then reassess!

58

Developing A Plan: what do you ask first?

Do they need rescuscitation/shock dose?

59

Resuscitation Phase parameters?

Pale mm
Increased HR/CRT
poor pulses
cool extremities
decreased mentation

60

Estimating Dehydration: subclinical?
Mild?
Moderate?
Severe?

5-6% 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

61

Replace sensible and insensible losses based on?
Alternate method?

Body Mass:Surface Area
Use maintenance fluid chart
(no chart available): 60 ml/kg/day****

62

Volume of GI losses usually underestimated by?

50%

63

What is normal urine production?
When should urine be considered in ongoing losses?

1-2 ml/kg/hr
>2 mL/kg/hr is ongoing loss

64

TQ!!! Maximum for KCl administration?
Why is it toxic?

0.5 mEq/kg/hr
Potassium affects RESTING potential

65

What does Ca2+ affect?

THRESHOLD potential

66

To correct fluid loss due to dysfunction of preload what should be given?

Volume

67

To correct fluid loss due to dysfunction of contractibility what should be given?

+ Inotrope

68

To correct fluid loss due to dysfunction of afterload what should be given?

Vasopressors

69

Speed of replacement for dehydration?
What is most physiological?

Rapid or over 24hr
slowly

70

What are rehydration needs?

Maintenance
Ongoing Losses
Deficit

71

Target for shock dose for Crystalloids is to expand blood volume by ____%?
Dog = ______mL/kg
Cat = ______mL/kg

30%
30 mL/kg DOG
20 mL/kg CAT

72

When giving shock fluids should you think dose or rate?

Dose!

73

Colloid Expanding effect depends on (2)?

1. Intact Endothelium
2. Presence of interstitial fluid

74

What should you give with colloids to begin tx of dehydration and allow optimal performance of colloid?

Give concurrent crystalloids!