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Exam 2
Shock
47
Veterinary Medicine
Professional
04/04/2016

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Cards

Term
What are some examples of sensible fluid loss?
Definition
-urination, defecation, vomiting
Term
What are some examples of insensible fluid loss?
Definition
-evaporation: respiration, skin, open body cavities
Term
What do baroreceptors respond to?
Definition
-dec in vascular stretch
-dec vagal tone
-inc HR and contractility
Term
Briefly describe out the Renin Angiotensin Aldosterone System.
Definition
-responds to dec BP/NA/SNS => Renin released from JG cells =? AT-1 to AT-2 (in lungs) => vasoconstriction, inc adlosterone, inc cardiac vagal response
Term
What percent of the BW is from water? What percentage of that is intacellular? Extracellular?
Definition
-60%
-60%
-40%
Term
Is sodium high in ICF, intravascular ECF, or interstitial ECF? What about Potassium? What about chloride?
Definition
-Sodium: high in intravascular and interstitial ECF
-Potassium: highest in intracellular
-Chloride: highest in intravascular and interstitial ECF
Term
What is an effective osmole? Give an example.
Definition
-solutes that cannot cross the cell membrane will contribute to the effective osmolality or tonicity
-ex: Dextrose -
Term
What is an ineffective osmole? Give an example.
Definition
-solutes that freely diffuse across the membrane do not contribute to tonicity
-ex: BUN
Term
Describe isotonic crystalloids. What are their function(s)?
Definition
-osmolality similar to plasma
-for the replacement of electrolytes and correction of acid/base disorders
-most common IVF used
Term
What do you do if you need to give lots of fluids at once?
Definition
-give a hypertonic solution to pull fluid intravascularly and then replace the fluids slowly with isotonic crystalloids
Term
Is Mannitol or Hypersonic salin solution safer?
Definition
-Hypertonic saline solutions
Term
What is a hypotonic crystalloid and how does it compare to isotonic crystalloids?
Definition
-lower tonicity than plasma
-Na and Cl is LOW and K is HIGH when compared to isotonic crystalloid sons
Term
What do we normally use hypotonic crystalloids?
Definition
-maintenance type solutions
Term
What is the primary concern with administration of hypotonic crystalloids? What are some examples of hypotonic crystalloids?
Definition
-admin slowly
-ex: Normosol-M (Acetate buffer), Plasma-Lyte M (acetate and lactate buffer)
Term
What is a synthetic colloid?
Definition
-macromolecular particles suspended in crytalloid fluid
Term
What are 3 examples of synthetic colloids?
Definition
-hydroxyethyl starches
-tetrastarch
-hetastarch
Term
What are the 3 major characteristics of dydroxyethyl starches that we are concerned with?
Definition
-mean molecular weight: average weight or numbered average size of the polymers
-molecular substitution: degree of substitution of glucose molecules with hyrodyethyl groups
-C2: C6 ratio: HE groups at the C2 position will inhibit the alpha-amylase better than at the C6 position
Term
Describe Tetrastarch in regards to the following characteristics:
a) speed of degradation
b) concentration
c) MW
d) average
e) MS
f) C2:C6
g) COP
h) expansion
Definition
a) rapidly degraded
b) 6% conc
c) MW 130
d) ave 70-60
e) MS 0.4
f) C2:C6 9:1
g) COP 37 mmHg
h) expansion 130%
Term
Describe HEtastarch in regards to the following:
a) speed of degradation
b) concentration
c) MW
d) Average
e) MS
f) C2:C6
g) COP
h) Expansion
Definition
a) slowly degraded
b) 6% concentration
c) MW 450
d) Average 69
e) MS 0.7
f) C2:C6 4:1
g) COP 33 mmHg
h) expansion 100%
Term
What are some possible adverse effects with Hetastarch?
Definition
-coagulopathy
Term
In what patients is hetastarch contraindicated?
Definition
-patients with renal dysfunction
Term
IN what animals should we use synthetic colloids?
Definition
-dec COP
-severe hypoproteinemia
-need for volume expansion
Term
What are two examples of natural colloids?
Definition
-plasma
-albumin (canine or human)
-fresh whole blood
-packed RBC
Term
When would we give plasma?
Definition
-coagulopathies, liver disease, rodenticide toxicity, hemophilia, etc
Term
What is shock?
Definition
-inability to deliver oxygen or the consumption is greater than the delivery leading to inadequate celluar energy production
Term
How does compensated shock present clinically?
Definition
-tachycardia
-hypertension
-increased CRT
Term
How do cats in shock appear?
Definition
-brady or tachycardic
-pale MM
-cold extremities, hypothermia
Term
What are the shock organs for the dog and horse? What about for cats, cattle, and pigs?
Definition
-GI tract
-pulmonary
Term
What is hypovolemia? Give some examples of some causes.
Definition
-dec in circulating blood volume
-ex: hemorrhage, severe dehydration (intestinal obstruction, GDV, colic, displaced abomasum, burns)
Term
What is cardiogenic shock?
Definition
-dec in forward flow to the heart
Term
What are the 4 hallmarks of cardiogenic shock?
Definition
-dec CO, dec venous return, dec SV, usually no vasodilation
Term
IS cardiogenic shock acquired or congenital?
Definition
-either
Term
True or False: Cardiogenic shock is usually associated with volume loss.
Definition
-FALSE, usually NOT associate dwith volume loss
Term
What are the main two types of vascular shock?
Definition
-distributive
-obstructive
Term
What is distributive vascular shock and what are some examples?
Definition
-vessels cannot respond to constrict so massive vasodialtion everywehre
-ex: sepsis, neurogenic, anaphylactic
Term
What are some examples of obstructive vascular shock?
Definition
-pericardial effusion
-severe HW dz
-GDV, colic, etc
Term
What is sepsis?
Definition
-immense systemic inflammatory response leading to a surge of cytoking release (inc vascular perm, causes coagulation abnormalitites, etc), persisitent hypotension
Term
Describe canine SIRS classification.
Definition
-greather than 40C or less than 38C
-HR > 120 bpm
-/+ hyperventilation, hypotensive, hypoglycemia
-high WBC
Term
Describe felie CIRS classification.
Definition
-usually hypothermic
-low to inc HR
-/+ hyperventilation, hypotensive, hypoglyceia, anemia
-high to low WBC
Term
Give an example of neurogenic shock.
Definition
-spinal cord trauma
-causes loss of vasomotor control
Term
What results from anaphylactic shock?
Definition
-massive histamine release
Term
What is metabolic shock?
Definition
-shock cuased by deranged cellular metabolic machinery
Term
What is hypoxemic shock?
Definition
-dec oxygen content in arterial blood
Term
With transfusions during surgery, at what point of blood loss do we seee profound CV disturbances?
Definition
-15-20%
Term
At what point do we give an infusion?
Definition
-15-20% blood loss
-concentration of Hb below DO2 (extent that anaerobic met will ensue)
-look at: intravascular vol, evidence of shock, acute vs chronic, CV parameters
Term
How do we treat shock?
Definition
-fludis
-inotropic or vasopressor support
-antibiotics
-protectants
-LOTS of monitoring
Term
Why do we need to maintain circulatory volume with perioperative fluid therapy?
Definition
-optimize end-organ perfusion and oxygen delivery
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