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ECC Flashcards

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1
Q

What is shock?

A

Inadequate cellular energy production.

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2
Q

Outline the clinical signs consistent with shock.

A
  • Reduced mentation
  • Altered mucous membrane colour
  • Prolonged CRT
  • Cold extremities
  • Tachycardia
  • Weak/thready femoral pulse
    *
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3
Q

What is SIRS?

A

Systemic inflammatory response syndrome.

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4
Q

What is Sepisis?

A

SIRS with an infectious agent.

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5
Q

What is severe SIRS/sepsis?

A

Sepsis, associated with:
* Organ dysfunction
* Hypoperfusion
* Hypotension

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6
Q

What is MODS?

A

Multiple Organ Dysfuntion Syndrome.

Altered organ function in an acutely ill patient such that homeostasis can not be maintained without intervention.

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7
Q

What is refactory (septic) shock?

A

A subset of severe sepsis defined as: Sepsis induced hypotension despite adequate fulid resuscitation.

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8
Q

What are the types of shock?

7

A
  • Hypovolaemic
  • Cardiogenic
  • Distributive
  • Metabolic
  • Hypoxaemic
  • Cryptic
  • Combined
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9
Q

What is cardiogenic shock?

A

Decreased forward flow from the heart. Multiple causes including: CHF, drug overdose, tamponade (compression of heart by fluid in pericardial sack).

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10
Q

What is distributive shock?

A

Loss of systemic vacular resistance

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11
Q

What is metabolic shock?

A

Deranged cellular metabolic machinery.

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12
Q

What is cryptic shock?

A

Normal global circulation but poor microcirculation (capillaries)

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13
Q

What is the ‘shock organ’ in dogs?

A

The GI tract

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14
Q

Outline the clinical signs of an animal with a fluid deficit of < 5%.

A

No clinically detectable signs.

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15
Q

Outline the clinical signs of an animal with a fluid deficit of 5-7%.

6

A
  • Mild depression
  • Slightly prolonged CRT
  • Slight increase in heart rate
  • Increased blood lactate concentration
  • Creatinine levels increased
  • Concentrated urine
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16
Q

Outline the clinical signs of an animal with a fluid deficit of 10%.

8

A
  • Depressed
  • May have cold extremities
  • Dry mucous membranes
  • CRT >3 seconds
  • Heart rate 50% greter than normal
  • Increased blood lactate
  • Increased creatinine
  • Small volume of very concentrated urine
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17
Q

Outline the clinical signs of an animal with a fluid deficit of 12-15%.

8

A
  • Depressed
  • Cold extremities
  • Dry mucous membranes
  • CRT >4 seconds
  • Heart rate 100% greater than normal
  • Increased blood lactate concentrations
  • Increased creatinine
  • Unliekely to produce any urine
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18
Q

Outline hypotonic fluids.

1

A

5% dextrose

Glucose moved into cells, making it like sterile water

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19
Q

Outline isotonic fluids

3

A
  • Hartmanns (LRS)
  • 0.9% saline
  • 5% dextrose in 0.9% saline
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20
Q

Outline hypertonic fluids

2

A
  • Hypertonic saline (any above 0.9%)
  • Parentral nutrition.
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21
Q

What are the benefits of hypertonic saline?

5

A
  • Attractive if there is a limited period of time for resucscitation
  • Vasodilation
  • Increased cardiac contractility
  • Immuno-mudulatory effects
  • Benefit for intracranial hypertension
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22
Q

What are the drawbacks of hypertonic saline?

6

A
  • Hypernatraemia
  • May cause neurological signs if excessive amounts are used
  • Bradycardia (if adminsitered too fast)
  • Hypotnetsion (if adminsitered too fast)
  • Can’t use in dehydrated patients
  • Can’t be used in foals
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23
Q

When is hartmann’s (LRS) not appropriate?

3

A
  • Renal failure
  • Hypernatraemia
  • Hyponatraemia
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24
Q

What fluids are used per rectum and in what cases?

5

A

Water (tap)

  • Oesophageal tear
  • Tetanus
  • Gastric impaction
  • Cost
  • Where an IV can’t be obtained.
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25
What are the indicators for a blood transfusion? | 5
* Anaemia * Coagulopathy * Thrombocytopenia * Thrombopathia * Hypoproteinaemia
26
What is the dog universal donor?
DEA 1.1 negative
27
What is the universal equine donor?
AaQa negative
28
What are the effects of protein catabolism? | Importance of nutrition (4)
It leads to: * Impaired tissue synthesis * Immunodeficiencies * Reduction in GI integrity * Affects drug metabolism
29
How is RER calculated
70*BW^0.75 Or 30*BW + 70
30
Outline the different forms of feeding tubes and which require surgical placement (SP)? | 5
* Syringe feeding * Naso-oesophageal/gastric tube * Oesophagostomy (SP) * Gastrostomy (SP) * Enterostomy (SP)
31
Outline common problems with feeding tubes.
* Blockages * Dislodging of the tube * Trauma * Infection * Over-granulation
32
Outline the advantages of parenteral nutrition | 4
When the entral route is not feasible: * Nausea/vomiting * Cannot protect the airway * Animal too sick to eat * To avoid collic
33
Outline the disadvantages of parenteral nutrition | 8
* Requires 24 hour monitoring * Requires glucose monitoring * Vascular access needed * Expensive * Don't provide complete nutrition * Requires electrolytes and trace-elements * Drug-nutrient interactions * Microbial contamination
34
Outline the primary casues of TBI | 2
* Damage caused by trauma (kick to head, RTA) * Haemorrhage and oedema into sealed crainal space
35
Outline possible secondary injuries | 3
* Excitatory neurotransmitters * Reactive oxygen species * Pro-inflammatory cytokines
36
What can secondary injuries lead to? | 4
* Cerebral oedema * Increased intra-cranial pressure * Compromise to the blood-brain barrier (by cytokines) * Alertations in cerebrovascular reactivity.
37
What systemic contributions can worsen secondary brain injury? | 7
* Hypotension * Hypoxia * Hypoglycaemia * Hyperglycaemia * Hypercapnia * Hypocapnia * Hyperthermia
38
Outline diagnositc steps for TBI
* Full neurological exam * Modified Glasgow coma scale used often
39
Outline how the MGCS works
Higher scores correlate with a better prognosis.
40
Outline the treatment principles for TBI | 3
* Correct tissue perfusion problems. * Decrease ICP by reducing oedema * Minimise increases in cerebral metabolic rate.
41
Outline the basics of fluid therapy in cases with TBI.
Use fluid therapy to solve hypovoleamia. 7.2% hypertonic saline rapidly restores circulating volume. 4ml/kg over 3-5 mins.
42
Outline the basics of CO2 monitoring with TBI.
Use blood gas analysis and pulse Ox to monitor PaCO2 levels. Hypercapnia leads to vasodilation and the woresening of ICP. Hypocapnia results in vasoconstriction and reduced intra-cerebral perfusion. Aim for 40 mmHg
43
Outline temperature control with TBIs.
Do not activly warm hypothermic patients. Do actively cool hyperthermic patients.
44
Outline the use of analgesia and anti-convulsant therapy.
Analgesia should be used. Opiods are likely to be effective. Anti-convulsant therapy with phenolbarbitone is also beneficial. Especially in the first week.
45
Should steroids be used?
No
46
Outline the principles of motility modification when treating TBI.
Maintain motility using cisapride or ranitadine and metaclopramide. Gut motility is vital in treating TBI.
47
Outline the role of nutirition when treating TBIs.
Vital Entrally feed if possible as this maintains integrity of GI mucosa. However, if not possible (patient unconscious), parentral nutrition should be used. Monitor glucose levels and use insulin. Pro-kinetics and maropitant may need to be used.
48
Outline what parameters you would monitor in a patient with TBI. | 3
* MGCS - looking for improvements in 24-48hrs * Blood pressure (hypovolaemia) * Blood gas (hypoxia/Hype/ocapnia)
49
What follow-ups can be done for patients with UTIs?
Advanced imagery Urinary catheters
50
Outline the advantages of CT scanning. | 2
* Higher sensitivity and specificity than ultrasound/radiography for detection of free fluid/gas and organomegaly. * Quick to obtain images once in the scanner
51
Outline the disadvantages of CT scanning. | 3
* Images need to be interpreted by a radiologist. * Slow to pre the patient - GA needed. * Limited avaliability.
52
Outline the advantages of MRI | 2
* Excellent for diagnosis of intracranial lesions and spinal lesions. * Excellent for equine distal limb lameness
53
Outline the disadvantages of MRI | 3
* Slow both to take image and for interpretation * Very rare * GA required
54
Outline the advantages of radiology | 4
* Good sensitivity and specificity for free gas. * Good for orthopeadic emergencies * Easy to perform * Can be used for a wide range of body systems
55
Outline the disadvantages of radiology | 2
* GA required * Limited assesment of actual organs (apart from size/location)
56
Outline the uses of endoscopy
* Excellent for upper respiratory distress in horses. * Can be used for curative intervention (i.e. removal of foreign bodies) * Requires GA in SA
57
Outline the advantages of ultrasound | 6
* No GA required * Can examine abdmonial organs * Can examine lung surface * Can be used for other soft tissue structures like tendons and ligaments. * Allows for interventions. For example, ultrasound guided biopsy etc * Non-invasive
58
Outline the disadvantages of ultrasound.
* Does not allow assesment of deep throacic structures * Can not asses airways
59
Outline the uses of a FAST scan in equine practice.
Used to assess colic cases
60
What are the locations used in a FLASH scan?
1. Ventral abdomen 2. Gastric 3. Spleno-renal 4. Left middle third of abdomen 5. Duodenal 6. Right middle third of abdomen 7. Cranioventral thoracic | Fast localised Abdominal Sonography of Horses
61
What are the key things looked at during a FAST scan?
* Free fluid * Apperance of the small intestine (degree of dilation/turgidity and motility)
62
Outline the five views involved in a T-FAST exam of the Dog.
1. Chest tube site (each side) - the 7-9 intercostal spaces. 2. Pericardial chest site (each side) - between the 5-6 intercostal space. 3. Diaphragmatico-hepatic view.
63
What does a T-FAST exam assess?
it id designed to rule in/out air/fluid in the pleural space and the presence of fluid in the pericardial space.
64
Identify the sites for an A-FAST exam.
1. Diaphragmatico-hepatic 2. Cysto-colic 3. Hepato-renal - right flank site 4. Spleno-renal - left flank site
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