VNSA15 + 16 Flashcards

Question

Distributive shock.

Answer 1

Where an animal suffers an abnormal blood volume distribution due to generalised and excessive dilation of the blood vessels. Caused by - sepsis, severe pancreatitis, major tissue trauma, GDV, burns Clinical signs: dark pink/red mm and rapid then slow CRT, tachycardia, poor pulse quality. Neurogenic - results from CNS trauma causing acute vasodilation Anaphylactic shock - caused by an allergic reaction to a substance results in peripheral resistance and vasodilation Endotoxic shock - septic - toxins are released from bacteria causing a disturbance in blood distribution.

Answer 2

Occurs when the heart is unable to pump blood adequately around the body. Consider - cardiomyopathy, heart and valve disease, severe arrhythmias Clinical signs: heart murmur, irregular pulses, tachycardia or bradycardia. Care with IVFT as inc blood volume makes the heart work harder.

Answer 3

Caused by an obstruction of the blood flow through the heart or back to the heart. Consider - pericardial effusion or cardiac tamponade, constructive pericarditis, pulmonary thromboembolism Clinical signs - tachycardia/bradycardia, heart murmurs and irregular pulses. Can be seen in conjunction with hypovolaemic shock.

Answer 4

Electrolyte solutions that can pass freely out of the blood stream via the capillary membrane into the interstitial fluid.

Answer 5

Isotonic crystalloids- as replacement or maintenance fluids Hypertonic fluids- Expands plasma volume by drawing fluid out of cells into extracellular space. used in large hypovolaemic patients when isotonic fluids cant be administered at a high enough rate. Must follow with isotonic crystalloids. Hypotonic fluids are rarely indicated.

Answer 6

Contains molecules with a large molecular weight meaning they cant leave the vascular system. They inc osmotic pressure of the blood, pulling fluid from the extracellular space into the vasculature. Uses - hypovolaemic or hypoproteinaemia patients

Answer 7

Bright red, spurting in nature

Answer 8

Dark red, continuous in nature

Answer 9

Bright red, continuous in nature

Answer 10

Occurs at the time of injury, trauma or surgery

Answer 11

Occurs 7-14 days after trauma or surgery. Cause - induction and sloughing away of blood vessels

Answer 12

Occurs 24-48hrs following trauma or surgery. Causes - slipping away of ligatures, dislodgement of clots, cessation of reflex vasospasm, normalisaition of bp

Answer 13

No improvement of the symptoms of shock. Could be related to inc losses or inadequate volumes of fluid.

Answer 14

The volume of fluid administered is greater than can be excreted. Symptoms - dyspnoea, tachypnoea, fluid on chest, polyuria, heart failure, abnormal hr, oedema, lethargy Actions - diuretics, take off fluids/reduce rate, O2 support

Answer 15

Pressure exerted by a fluid at a given point, due to the weight of the fluid above it.

Answer 16

The pressure that results from the heart pushing blood through the vessels

Answer 17

Cations = Sodium, calcium Anions = chloride bicarbonate

Answer 18

Cations = potassium, magnesium Anions = phosphate

Answer 19

Adult large dogs - 1.5ml/kg/hr Very small dogs - 4ml/kg/hr Adult cats - 2-3ml/kg/hr Kittens - up to 6ml/kg/hr Note - obese animals calculated on a reduced bw. Pyrexia increases fluid requirements by 3ml/kg/degrees above normal temp

Answer 20

-Communicates w hypothalamus causing thirst -osmoreceptors release ADH and stimulate reabsorption of water. -released of renin: angiotensin = vasoconstriction and aldosterone = inc sodium retention = inc water reabsorption.

Answer 21

Water lost from the extracellular fluid first causing a move from the Intracellular -> extracellular to maintain a balance. (Osmotic equilibrium) Eg - lack of water available, excessive panting, fever, diabetes insipidus

Answer 22

This occurs due to abnormal losses. Water and electrolytes move from the extracellular fluid and there is no movement from the Intracellular fluid to balance (maintain osmotic equilibrium) Eg - haemorrhage, V+ and D+

Answer 23

Hydrogen ions are produced as a result of normal metabolism, the body’s acid base balance is a measure of the hydrogen ion concentration within its tissues. Hydrogen ions are measure according to the pH scale (ranging from 1-14) Neutral pH = 7.35-7.45

Answer 24

Buffers - such as bicarbonate - used to soak up the hydrogen ions, preventing acidosis. Respiration - chemoreceptors monitor hydrogen ions and alter respiration accordingly, increasing ventilation inc the carbon dioxide expired and reduces acidosis. Renal system - hydrogen ions are excreted into the urine, reducing acidosis.

Answer 25

Metabolic acidosis drops due to bicarbonate buffers Respiratory acidosis inc due to carbonic acid

Answer 26

Metabolic alkalosis inc due to bicarbonate buffers. Respiratory alkalosis decreases due to carbonic acid

Answer 27

Not detectable. Hx suggests a deficit is present. Inc in urine concentration.

Answer 28

Subtle loss of skin elasticity

Answer 29

Marked loss of skin elasticity Slight prolonged CRT Slightly sunken eyes Dry MM

Answer 30

Tented skin that stands in place Proglonged CRT (>2 secs) Sunken eyes protruded 3rd eyelid Dry MM Progressive signs of shock

Answer 31

% dehydration X body weight (kg) x 10

Answer 32

Isotonic crystalloid (Hartmans) should be used. Mild hypovolaemia; Dog 5-10ml/kg and cat 3-5ml/kg Moderate hypovolaemia; Dog 10-20ml/kg and cat 5-10ml/kg Severe hypovolaemia; Dog 20-40ml/kg and cat 10-15ml/kg Rabbits; 10-15ml/kg

Answer 33

Initial bolus = Dog 5-10ml/kg and cat 2-5ml/kg Total bolus = Dog 20ml/kg and cat 10ml/kg

Answer 34

Site of IV and gauge Date of insertion When and what it was flushed Bandage checks Any complications \ IVFT rate and running

Answer 35

Hypovolaemia - no improvement on IVFT Hypervolaemia - too much fluid given Tissue oedema Cardiac disease Renal insufficiency Inc intracranial pressure - head trauma, intracranial masses ands seizure patients

Answer 36

Currently 7 recognised antigen types in the DEA system 1, 3, 4, 5, 6, 7, 8, (no commercial testing for 6 & 8 yet) DEA 1 is the most antigenic meaning it’s most likely to cause an immune reaction. DEA = dog erythrocyte antigens Universal donor = dog that is neg for 1, 3, 5, & 7 and positive for DEA 4 Commercial testing only available for DEA 1 (1.1 and 1.2) positive or negative Naturally occurring alloantibodies are uncommon in the dog, so a DEA 1.1 -ve recipient who is having a blood transfusion for the FIRST time can be given DEA 1.1+ve blood. The recipient will then produce alloantibodies 4+ days meaning if they receive DEA 1.1+ve blood again an immune-mediated response will occur.

Answer 37

Blood typing cards - visually aggultination in patient test well = DEA 1+ve. Cannot rely on this testing type with IMHA patients Alvedia quick test - strip of antibodies on absorbent paper strip. RBCs with DEA antigen stick to strip and show as red line = DEA +ve. No red line indicates DEA-ve Agglutination shouldn’t affect results.

Answer 38

3 blood types A - most common B - rare AB - really rare Strong geographical and breed specific prevalence Naturally occurring alloantibodies to the foreign antigen and will have an immunological reaction. (1ml of A given to a B cat could be fatal) No universal donor cats - cats should be blood typed and correct blood given, cross matching should occur if possible.

Answer 39

If patient shows agglutination in the well marked Type A, the cat has blood group A If patient shows agglutination in the well marked Type B, the cat has blood group B If patient shows agglutination in both patient wells, the cat has tested blood group AB Cross matching - tests performed to determine whether the antibodies in the patients plasma against red blood cells in the donor and vice versa. This is essential if the animal has had a previous blood transfusion or unknown transfusion history. Test is carried out by an ext lab - 2 types: Major cross match - donor RBCs are mixed with recipients serum Minor cross match - donor serum is mixed with recipients RBCs This decreases risk of acute haemolytic reactions

Answer 40

RBCs, functional platelets, coagulation factors and plasma proteins Collected directly from donor in a ‘closed’ system and given directly to the recipient 1 unit = 450ml Must be used within 4-6hrs Uses - acute, severe haemorrhage. Anaemia if no other blood products available

Answer 41

This is fresh blood that has been stored at 1-6 degrees Celsius until use Platelets no longer viable after 72hrs and SOME coagulation factors also lost RBCs, non-labile clotting factors, antithrombin and plasma proteins Collected Store - up to 21 days Uses - same as fresh whole blood

Answer 42

Produced when a unit of fresh whole blood is centrifuged = RBCs and very little plasma components Store - 42 days from date of production 1 unit = 250ml Uses - anaemia ( to inc oxygen carrying capacity) and in blood loss if no whole blood is available ( may also consider giving alongside FFP)

Answer 43

FFP - coagulation factors and plasma proteins Separated from RBCs by centrifuge Then frozen to -18 within 24hrs of collection Expires after 1 year Uses - coagulopathy, rodenticide tox, vow deficiency, haemophilia A, desemenated intravascular coagulation (DIC) and hypoalbuminaemia FP - coagulation factors except ( V, VIII, IX, vWF) and plasma proteins Collected Store Either FFP after it has expired OR plasma that wasn’t frozen within 24hrs Expires after 4 years Uses - rodenticide toxicity, specific coagulation deficiency

Answer 44

50% of factor VIII and vWf, up to 40% fibrinogen and some factor XIII Made by slowly thawing a unit of FFP at 4 degrees Celsius until slushy Then centrifuged, supernatant removed. The precipitate remaining = cryoprecipitate Expensive & limited supply Uses - haemophilia A, vWB disease, hypofibrinogenaemia

Answer 45

Large internal/external haemorrhage = whole blood transfusion Anaemia due to lack of production or destruction of RBs = packed red blood cells (first choice) if not WHOLE blood (care as patient will have normal clotting factors) Coagulopathy - FFP/FP/cryo depending on which factors are needed

Answer 46

Formula: 80 (dog) 60 (cat) X BW X (desired PCV - recipient PCV) divided by PCV of the blood to be transfused Max volume that can be donated by dogs is 16-18ml/kg and take around 40-50ml in cats (8-10ml/kg) Rate of administration - usually slower for first 30mins (0.25ml/kg/hr) then increased over the next 1-4hrs. After 4hrs high risk of bacterial contamination. In normovolaemeic patients 5-10ml/kg. Can vary between 2ml/kg/hr up to 20ml/kg/hr depending on volume status. DON’T give at the same time as hartmans as causes chelation

Answer 47

Commercial collection and transfusion bags are available which contain one of the 2 anticoagulants: CPD - citrate phosphate dextrose CPDA-1 - citrate phosphate dextrose adenine (ACD-acid citrate dexrose_ is no longer used) CPD and CPDA-1 1ml coagulant: 7ml blood

Answer 48

1-8 years old 25kg+ Good temperament (generally no sedation required) Healthy No travel abroad No previous blood transfusion Up to date with vaccines/ f+w PCV >40%, blood type Annual haematology and biochem profiles and screened for infectious diseases.

Answer 49

1-8 years old > 4.5kg bw Healthy Fully vaccinated, f+w No prev blood transfusion Never been pregnant or had a litter Ideally an indoor cat Good temperament (light sedation often required) PCV >35% FeLV/FIV negative on blood testing, Mycoplasma haemofelis negative (full Haemotology, biochemistry and blood type)

Answer 50

Always via an appropriate blood filter to eliminate the possibility of clots and other tissue components in the blood creating a potential embolus. A standard transfusion set contains a 170 micrometre filter. ( use a haemonate filter for cats and small dogs) CARE - infusion pumps can damage RBCs, ideally use gravity flow.

Answer 51

Immune mediated - haemolytic transfusion reaction, febrile reactions, urticarial reactions, non-cardiogenic pulmonary oedema/transfusion related acute lung injury. Non-immune mediated - circulatory overload, citrate toxicity, haemolysis and hyperammonaemia Monitoring - HR, RR, pulse quality, resp effort, tachy/brady-cardia, tachy/dysp-noea, pyrexia, V+/D+, urticaria, restlessness, anything unusual for that patient

Answer 52

Haemolytic transfusion reaction - recipients antibodies destroying donors RBCs —> intravascular haemolysis Signs - pyrexia, tachy/bradycardia, hypotension/collapse, dysponea, weakness/seziures, cyanosis, haemoglobinuria STOP TRANSFUSION IMMEDIATELY, AGGRESSIVE SUPPORTIVE MANAGEMENT Febrile reactions - antibody reaction against donor leukocyte or platelet antigens. Signs - 1-2oc increase in temp within 1-2hrs of transfusion. Often self limiting, stop or slow transfusion + antihistamines Uticarial reactions - anaphylactic shock - binding of the antigen from donors blood products to preformed antibodies bound to recipients mast cells and basophils. Signs - puritis, erythema, urticaria, acute allergic reaction to signs of anaphylactic shock Stop or slow transfusion, antihistamines and steroids. Non-cardiogenic pulmonary oedema/ transfusion related ALI - possible leukocyte antigen reactions with aggregates trapped in the pulmonary circulation. Signs - resp distress without other signs of fluid overloads or acute hypersensitivity. Give IV fluids and oxygen Circulatory overload - due to administration of large volume of blood or very rapid administration. Signs - resp compromise, high RR, cough Provide oxygen and diuretics Citrate toxicity - rapid administration of citrate products, causing hypocalcaemia, more likely in those with hepatic impairment. Signs - V+, tremors, muscle spasms, cardiac arrest. Stop transfusion, slow IV calcium gluconate, ECG and HR monitoring Haemolysis - from excessive warming cooling or damage to RBCs during administration Signs - haemoglobinuria or haemoglobinaemia WITHOUT signs of immune mediated haemolytic reaction No treatment required, but the blood transfusion will not be effective Hyperammonaemia - excessive accumulation of ammonia during the storage of blood products, more common in those with liver impairment. Signs - similar to hepatic encephalopathy, irritability, disorientation, lethargy, seziures, coma, V+, D+ Supportive treatment required.

VNSA15 + 16 Flashcards

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